Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain ; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain ; Departamento de Medicina, Universidad de Sevilla, Seville, Spain.
PLoS One. 2013 Dec 23;8(12):e82958. doi: 10.1371/journal.pone.0082958. eCollection 2013.
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.
他汀类药物具有多种效应，可能影响某些传染病的预防和结果。目前尚无关于其对金黄色葡萄球菌菌血症（SAB）具体影响的信息。
对 2008 年 3 月至 2011 年 1 月期间在一家 950 张床位的三级医院住院的年龄≥18 岁的所有 SAB 患者进行前瞻性队列研究。主要结局变量为 14 天死亡率，次要结局变量为 30 天死亡率、持续性菌血症（PB）以及 SAB 诊断时存在严重脓毒症或感染性休克。通过多变量逻辑回归和 Cox 回归分析研究 SAB 发病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。
共纳入 160 例患者。33 例（21.3%）患者在 SAB 发病时正在接受他汀类药物治疗。14 天死亡率为 21.3%。调整年龄、Charlson 指数、Pitt 评分、充分治疗和高危源后，他汀类药物治疗对 14 天死亡率（调整 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，但对 30 天死亡率（OR=0.35；95%CI：0.10-1.23；p=0.10）或严重脓毒症或感染性休克的发生（调整 OR=0.89；95%CI：0.27-2.94；p=0.89）无显著影响。Cox 分析也未能证明 30 天死亡率的影响（调整 HR=0.5；95%CI：0.19-1.29；p=0.15）。
SAB 患者的他汀类药物治疗与早期死亡率和 PB 降低相关。需要进行随机研究以确定他汀类药物在治疗 SAB 患者中的作用。
