Effect of statin therapy in the outcome of bloodstream infections due to Staphylococcus aureus: a prospective cohort study.
Effect of statin therapy in the outcome of bloodstream infections due to Staphylococcus aureus: a prospective cohort study.
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DOI：
10.1371/journal.pone.0082958
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Rodríguez-Baño J
中科院分区：
文献类型：
--
作者：
López-Cortés LE;Gálvez-Acebal J;Del Toro MD;Velasco C;de Cueto M;Caballero FJ;Muniain MA;Pascual A;Rodríguez-Baño J
他汀类药物具有多效性，可影响某些感染性疾病的预防和转归。没有关于其对金黄色葡萄球菌菌血症（SAB）的特异性作用的信息。进行了一项前瞻性队列研究，包括2008年3月至2011年1月在950张床位的三级医院住院的年龄≥18岁的患者中诊断的所有SAB。主要结局变量为14天死亡率，次要结局变量为30天死亡率、持续菌血症（PB）和诊断SAB时存在严重脓毒症或脓毒性休克。通过多变量logistic回归和考克斯回归分析研究SAB发作时他汀类药物治疗的效果，包括他汀类药物治疗的倾向评分。共收录160集。33例患者（21.3%）在SAB发作时接受他汀类药物治疗。14-日死亡率为21.3%。校正年龄、Charlson指数、Pitt评分、适当管理和高风险来源后，他汀类药物治疗对14天死亡率（校正OR = 0.08; 95% CI：0.01-0.66; p = 0.02）和PB（OR = 0.89; 95% CI：0.27-1.00; p = 0.05）具有保护作用，尽管对30天死亡率（OR = 0.35; 95% CI：0.10-1.23; p = 0.10）或严重脓毒症或脓毒性休克（校正OR = 0.89; CI 95%：0.27-2.94; p = 0.8）的影响不显著。 考克斯分析也未证实对30天死亡率的影响（校正HR = 0.5; 95% CI：0.19-1.29; p = 0.15）。 SAB患者接受他汀类药物治疗与较低的早期死亡率和PB相关。随机研究是必要的，以确定他汀类药物在治疗SAB患者的作用。
Statins have pleiotropic effects that could influence the prevention and outcome of some infectious diseases. There is no information about their specific effect on Staphylococcus aureus bacteremia (SAB). A prospective cohort study including all SAB diagnosed in patients aged ≥18 years admitted to a 950-bed tertiary hospital from March 2008 to January 2011 was performed. The main outcome variable was 14-day mortality, and the secondary outcome variables were 30-day mortality, persistent bacteremia (PB) and presence of severe sepsis or septic shock at diagnosis of SAB. The effect of statin therapy at the onset of SAB was studied by multivariate logistic regression and Cox regression analysis, including a propensity score for statin therapy. We included 160 episodes. Thirty-three patients (21.3%) were receiving statins at the onset of SAB. 14-day mortality was 21.3%. After adjustment for age, Charlson index, Pitt score, adequate management, and high risk source, statin therapy had a protective effect on 14-day mortality (adjusted OR = 0.08; 95% CI: 0.01–0.66; p = 0.02), and PB (OR = 0.89; 95% CI: 0.27–1.00; p = 0.05) although the effect was not significant on 30-day mortality (OR = 0.35; 95% CI: 0.10–1.23; p = 0.10) or presentation with severe sepsis or septic shock (adjusted OR = 0.89; CI 95%: 0.27–2.94; p = 0.8). An effect on 30-day mortality could neither be demonstrated on Cox analysis (adjusted HR = 0.5; 95% CI: 0.19–1.29; p = 0.15). Statin treatment in patients with SAB was associated with lower early mortality and PB. Randomized studies are necessary to identify the role of statins in the treatment of patients with SAB.
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