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Continued Statin Use Benefits Patients with Bacteremia

MAR 30, 2017 | NICOLA M. PARRY, BVSC, MRCVS, MSC, DIPACVP ELS
In patients with Staphylococcus aureus bacteremia, continuation of statins among those who began receiving the therapy before the infection significantly lowered the risk of 30-day mortality, a new study suggests.
 
Aisling R. Caffrey, PhD, MS, from the University of Rhode Island College of Pharmacy in Kingston, RI, and colleagues published the results of their study online in Antimicrobial Agents and Chemotherapy.
 
Although statins are widely used because of their ability to significantly reduce the occurrence of cardiovascular events and death in patients with coronary artery disease or those at high risk of cardiovascular disease, their anti-inflammatory and immunomodulatory effects have also attracted research attention.
 
For example, there have been more than 50 studies in the past 15 years evaluating the protective effects of statins among patients with infections, said Dr. Caffrey in an interview with Contagion®. Yet, despite this extensive research, “we are no closer to using statins in clinical practice for the treatment of infectious diseases,” she added.
 
The reason for this, she explained, is that although some studies have demonstrated protective effects of these agents, others have not. It is also difficult to understand the reason for this discrepancy, she added, because many of the studies used different definitions of statin exposure.
 
“Therefore, we wanted to assess the impact of statins on infections using very specific statin exposure definitions that reflect real-world clinical practice.”
 
With this in mind, Dr. Caffrey and colleagues conducted a retrospective cohort study to examine how statin use affected clinical outcomes among patients with S. aureus bacteremia. Using data collected from Veterans Affairs hospitals from 2002 to 2013, they included 17,138 hospitalized patients with positive S. aureus blood cultures who had received appropriate antibiotic therapy within 48 hours of culture collection.
 
According to the researchers, 16,448 of these patients were nonusers of statins, 344 had begun statin therapy before the infection (pretreated) and discontinued it at culture, 159 were pretreated with continuation (for at least 3 days) after culture, and 187 were de novo users who began statin therapy at culture.
 
They found that patients who were pretreated and continued statin therapy after culture experienced a 54% lower 30-day mortality rate. However, these protective effects were not seen in patients who were either pretreated without continuation at culture or were de novo users.
“Clinicians would like to know whether they should start statins in patients with infections,” said Dr. Caffrey, “and while sufficient evidence for this has not been observed to date, the findings from our real-world observational study do support continuation of statin therapy in those patients on statins prior to the infection. Our findings are supported by previous observational and clinical trial research.”
 
In their publication, the authors also explain that patients should keep taking statins through the period of inflammation because the beneficial effects of the drugs on the inflammatory response disappear as soon as treatment stops.
 
“Next, we will evaluate whether there is a specific statin medication, dose, and duration, that provides the greatest clinical benefit—again using real-world data which can help inform future clinical trials,” Dr. Caffrey concluded.
 
Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.
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