Statin Therapy and Decreased Incidence of Positive Candida Cultures Among Patients With Type 2 Diabetes Mellitus Undergoing Gastrointestinal Surgery

• Published in: Mayo Clinic proceedings Vol. 85; no. 12; pp. 1073 - 1079
• Main Authors: Spanakis, Elias K., MD, Kourkoumpetis, Themistoklis K., MD, Livanis, Grigorios, PhD, Peleg, Anton Y., MD, PhD, MPH, Mylonakis, Eleftherios, MD, PhD
• Format: Journal Article
• Language: English
• Published: Rochester, MN Elsevier Inc 01.12.2010; Mayo Foundation; Elsevier, Inc; Elsevier Limited; Mayo Foundation for Medical Education and Research
• Subjects: Aged; Biological and medical sciences; Candidiasis; Candidiasis - microbiology; Candidiasis - prevention & control; Care and treatment; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - microbiology; Diabetes Mellitus, Type 2 - surgery; Diabetes. Impaired glucose tolerance; Dosage and administration; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Internal Medicine; Logistic Models; Lower Gastrointestinal Tract - microbiology; Lower Gastrointestinal Tract - surgery; Male; Medical sciences; Middle Aged; Original; Postoperative Complications - drug therapy; Postoperative Complications - microbiology; Postoperative Complications - prevention & control; Prevention; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Statins; Type 2 diabetes; United States; OR; AOR; CI; CCI; length of hospital stay; DM; central venous catheter; diabetes mellitus; HR; odds ratio; adjusted odds ratio; Charlson Comorbidity Index; CVC; LOS; hazard ratio; confidence interval; ICU; intensive care unit; Endocrinopathy; Type 2 diabetes; Human; Candidiasis; Mycosis; Metabolic diseases; Patient; Statin derivative; Epidemiology; Incidence; Fungi; Infection; Medicine; Treatment; Candida; Fungi Imperfecti; Cultural aspect; Culture; Antilipemic agent
• ISSN: 0025-6196; 1942-5546
• DOI: 10.4065/mcp.2010.0447

OBJECTIVE To assess whether statin therapy decreases the incidence of cultures positive for Candida species among high-risk hospitalized patients with type 2 diabetes mellitus (DM). PATIENTS AND METHODS We performed a retrospective cohort study analyzing the records of all patients with type 2 DM who were admitted to Massachusetts General Hospital for lower gastrointestinal tract surgery between January 1, 2001, and May 1, 2008. We defined statin exposure as the filling of at least 1 prescription of statins during the 6 months before hospitalization or during the current hospital stay. The primary outcome was a culture positive for Candida species during hospitalization. Clinical information on a wide range of covariates was collected. Logistic regression analysis was used to adjust for possible confounders. RESULTS Of the 1019 patients who were eligible for the study, 493 (48%) were receiving statins. A total of 139 patients (14%) had at least 1 culture positive for Candida species during hospitalization. An adjusted multivariate model based on a backward stepwise elimination procedure showed that statin therapy significantly decreased the incidence of cultures positive for Candida species (odds ratio, 0.60; 95% confidence interval [CI], 0.38-0.96; P =.03) with a statistically significant prolonged time to event compared with no statin therapy (adjusted hazard ratio, 0.62; 95% CI, 0.44-0.88; P =.01). The benefit of statins was more prominent in patients with type 2 DM who had greater comorbidities (Charlson Comorbidity Index ≥2) (adjusted odds ratio, 0.47; 95% CI, 0.27-0.79; P =.01). CONCLUSION Among patients with type 2 DM who underwent gastrointestinal surgery, use of statins correlated with a decreased incidence of cultures positive for Candida species.