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Open Access Research article

Statins in Candidemia: clinical outcomes from a matched cohort study

Graeme N Forrest1*, Angela M Kopack2 and Eli N Perencevich3

Author Affiliations

1 Division of Infectious Diseases, Oregon Health Sciences University and Portland VA Medical Center, Portland, 3701 SW US Veterans Hospital Rd, P3-ID, Portland, OR, 97239, USA

2 Infectious Diseases Associates, Ellicott City, MD, 21201, USA

3 Professor of Medicine, University of Iowa Carver College of Medicine, Iowa City VA Medical Center, 200 Hawkins Dr, SE620GH, Iowa City, IA, 52242, USA

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BMC Infectious Diseases 2010, 10:152  doi:10.1186/1471-2334-10-152

Published: 4 June 2010

Abstract

Background

HMG CoA reductase inhibitors (statins) in patients with bacteremic sepsis have shown significant survival benefits in several studies. There is no data on the effect of statins in candidemic patients, however in-vitro models suggest that statins interfere with ergesterol formation in the wall of yeasts.

Methods

This retrospective matched- cohort study from 1/2003 to 12/2006 evaluated the effects of statins on patients with candidemia within intensive care units. Statin-users had candidemia as a cause of their systemic inflammatory response and were on statins throughout their antifungal therapy, while non-statin users were matched based on age +/- 5 years and co-morbid factors. Primary analysis was 30-day survival or discharge using bivariable comparisons. Multivariable comparisons were completed using conditional logistic regression. All variables with a p-value less than 0.10 in the bivariable comparisons were considered for inclusion in the conditional logistic model.

Results

There were 15 statin-users and 30 non-statin users that met inclusion criteria, all with similar demographics and co-morbid conditions except the statin group had more coronary artery disease (P < 0.01) and peripheral vascular disease (P = 0.03) and lower median APCAHE II scores (14.6 vs 17, p = 0.03). There were no differences in duration of candidemia, antifungal therapy or Candida species between the groups. Statins were associated with lower mortality on bivariable (OR 0.09, 95% CI 0.11-0.75, p = 0.03) and multivariable (OR 0.22, 95% CI 0.02-2.4, p = 0.21) analyses compared to controls; although, in the latter the protective effect lacked statistical signficance.

Conclusion

In our small, single-center matched-cohort study, statins may provide a survival benefit in candidemia, however further studies are warranted to validate and further explore this association.