Health outcomes of statin users compared to non-users with Clostridium difficile infection

Background: Clostridium difficile infection (CDI) is the most common cause of nosocomial diarrhea, and the primary cause of healthcare-associated infections in the United States. Statins have beneficial effects independent of their lipid-lowering effects; these pleiotropic effects may include anti-inflammatory and immunomodulatory activity. The potential role for statins in CDI is unique in that both the cholesterol-lowering and pleiotropic effects of statins could lead to improvements in clinical response for patients with CDI. Rationale: Limited data currently exist in the literature on the outcomes of statin users who develop CDI compared with non-users. The primary objective of this study was to compare CDI health outcomes in statin users and non-users in a national cohort of patients from a single-payer health system. Methods: This was a longitudinal, retrospective cohort study of all adult CDI patients receiving care from the Veterans Health Administration. Patients were divided into two groups based on statin exposure prior to and during the first CDI encounter. For the primary analysis, we created a propensity score-matched cohort to account for variables associated with indications for statin use. Once the matched cohort was derived, additional variables known to impact CDI outcomes were entered into a multivariable logistic regression model in order to determine the risk of individual CDI outcomes. Results: CDI outcomes were evaluated for statin users and non-users before and after propensity score-matching. In the unmatched cohort, statin use was significantly associated with reduced risk of 30-day mortality (aOR 0.60, 95% CI 0.36-1.00, p=0.0478). In the matched cohort, statin use remained significantly associated with a reduced risk of 30-day mortality (aOR 0.45, 95% CI 0.23-0.88, p=0.0198). No significant trends were found for inpatient mortality, 60-day recurrence, and severe or complicated CDI. Conclusion: This is the largest study comparing CDI health outcomes among statin users and non-users. Statin users were found to have significantly reduced 30-day mortality in both an unmatched and matched patient cohort compared to non-users. While these data support previous findings reported in the literature, no change in routine care of CDI patients can be recommended at this time.Pharmaceutical Science

Global burden of Clostridium difficile infections::a systematic review and meta-analysis

Background: Clostridium difficile is a leading cause of morbidity and mortality in several countries. However, there are limited evidence characterizing its role as a global public health problem. We conducted a systematic review to provide a comprehensive overview of C. difficile infections (CDI) rates.Methods: Seven databases were searched (January 2016) to identify studies and surveillance reports published between 2005 and 2015 reporting CDI incidence rates. CDI incidence rates for health care facility-associated (HCF), hospital onset-health care facility-associated, medical or general intensive care unit (ICU), internal medicine (IM), long-term care facility (LTCF), and community-associated (CA) were extracted and standardized. Meta-analysis was conducted using a random effects model.Results: 229 publications, with data from 41 countries, were included. The overall rate of HCF-CDI was 2.24 (95% confidence interval CI = 1.66- 3.03) per 1000 admissions/y and 3.54 (95%CI = 3.19-3.92) per 10 000 patient- days/y. Estimated rates for CDI with onset in ICU or IM wards were 11.08 (95%CI = 7.19-17.08) and 10.80 (95%CI = 3.15-37.06) per 1000 admission/ y, respectively. Rates for CA-CDI were lower: 0.55 (95%CI = 0.13- 2.37) per 1000 admissions/y. CDI rates were generally higher in North America and among the elderly but similar rates were identified in other regions and age groups.Conclusions: Our review highlights the widespread burden of disease of C. difficile, evidence gaps, and the need for sustainable surveillance of CDI in the health care setting and the community.</p

A possible association between statin use and improved Clostridioides difficile infection mortality in veterans.

Clostridioides difficile infection (CDI) is the most common cause of nosocomial diarrhea and places a significant burden on patients and the health care system. Statins could lead to improvements in CDI clinical response due their pleiotropic effects, including immunomodulatory and lipid-lowering effects; however, few studies have assessed this association. The primary objective of this study was to compare CDI health outcomes in statin users and non-users in a national cohort of patients. This was a retrospective cohort study of all adult CDI patients receiving care from the Veterans Health Administration from 2002 to 2014. Patients were divided into two groups based on statin exposure 90 days prior to and during their first CDI encounter. CDI health outcomes, including mortality and CDI recurrence, were compared using a propensity-score matched cohort of statin users and non-users and multivariable logistic regression. A total of 26,149 patients met study inclusion criteria, of which 173 statins-users and 173 non-users were propensity score matched. Thirty-day mortality was significantly lower among statins users with CDI (12.7%) compared to non-users (20.2%) (aOR 0.34; 95% CI 0.16-0.72). Sixty-day CDI recurrence was non-significantly lower among statin-users (9.0%) compared to non-users (16.6%) (aOR 0.68; 95% CI 0.29-1.59). In this nationally-representative study of veterans with CDI, statin use was associated with lower 30-day mortality compared to non-use. Statin use was not associated with 60-day CDI recurrence

National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014.

Prior studies demonstrated marked increases in Clostridium difficile infection (CDI) in the United States (U.S.) in recent years. The objective of this study was to describe the epidemiology of initial and recurrent CDI in a national Veterans Health Administration (VHA) cohort over a 12-year period.This was a retrospective cohort study of all adult VHA beneficiaries with CDI (ICD-9-CM code 008.45) plus a positive CDI stool test between October 1, 2002 and September 30, 2014. Data were obtained from the VA Informatics and Computing Infrastructure. Recurrence was defined as a second ICD-9-CM code plus a new course of CDI therapy following a minimum three-day gap after the initial therapy was completed. CDI incidence and outcomes were presented descriptively and longitudinally.Overall, 30,326 patients met study inclusion criteria. CDI incidence increased from FY 2003 (1.6 per 10,000) to FY 2013 (5.1 per 10,000). Thereafter, CDI incidence decreased through FY 2014 (4.6 per 10,000). A total of 5,011 patients (17%) experienced a first recurrence and, of those, 1,713 (34%) experienced a second recurrence. Recurrence incidence increased 10-fold over the study period, from (0.1 per 10,000) in FY 2003, to (1.0 per 10,000) in FY 2014. Overall, 30-day mortality and median hospital length of stay (LOS) decreased among initial episodes over the study period. Mortality was higher for initial episodes (21%) compared to first recurrences (11%) and second recurrences (7%). Median hospital LOS was longer for first episodes (13 days) compared to first (9 days) and second recurrences (8 days).Initial and recurrent CDI episodes increased among veterans over a 12-year period. Outcomes, such as mortality and hospital LOS improved in recent years; both of these outcomes are worse for initial CDI episodes than recurrent episodes

Baseline characteristics of matched cohort.

Baseline characteristics of matched cohort.</p