Effect of Statin Use on the Outcomes of Adults with Candidemia

Ref ID: 18765

Author:

G. Cuervo, MD – Physician, C. Garcia-Vidal, PhD – Physician, M. Nucci, MD – Professor, F. Puchades, MD – Physician, M. Fernandez-Ruiz, MD – Physician, A. Mykietiuk, PhD – Physician, A. Manzur, PhD – Physician, C. Gudiol, MD – Physician, J. Peman, MD

Author address:

Hosp. de Bellvitge, Barcelona, Spain.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: It has been suggested that statins may be useful to improve outcomes of pts with infections due to its immunomodulatory properties. Moreover, in vitro studies have found that statins diminish the levels of ergosterol and cause deletions in the mitochondrial genome of yeasts, hindering fungal growth. We sought to determine the effect of prior statin use on the clinical outcomes of adults with candidemia. Methods: Multicenter retrospective cohort study of hospitalized pts with candidemia (2005-2011) in six hospitals. Results: Of 403 candidemias, 59 (14.6%) occurred in pts receiving statins. Pts on statin therapy were older (62 vs 57 y; p=.004) and had more frequently diabetes mellitus (48 vs 24%; p=.001), renal diseases (34 vs 20%; p=.021), heart diseases (58 vs 23%; p<.001), solid organ transplantation (19 vs 9%; p=.026), and prior surgery (58 vs 44%; p=.002). Conversely, they had less liver diseases (5 vs 19%; p=0.004), neutropenia (0 vs 13%; p=.001), and had received less frequently chemotherapy (9 vs 20%; p=0,033). The median value of APACHE II was similar (18 vs 17). The most common sites of candidemia were: unknown source (48 vs 49%), catheter-related (23 vs 19%), urinary tract (10 vs 17%) and esophagitis (8 vs 3%). Candida albicans was the most common species followed by C. parapsilosis, C. tropicalis, C. glabrata, and C. krusei. There were no differences regarding appropriate empirical antifungal treatment between groups. The most common antifungal therapy was fluconazole. No differences were observed in persistent candidemia, stability at 48 hours, and septic metastasis. Pts on statin therapy had lower early (5 d) case fatality rate (5 vs 17%; p=0,011). This effect was not observed with other cardiovascular drugs (aspirin, beta blockers and ACE inhibitors). Overall (30 d) case fatality rate was similar between groups (41 vs 48%; p=0.43). The results were equivalent when neutropenic pts were excluded. Conclusions: The use of statins may have a beneficial effect on outcomes of pts with candidemia. This hypothesis deserves to be evaluated in prospective studies.

Abstract Number: M-329

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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