Statins Protect Against Candida Infection in Hospitalized Diabetics

Exposure to statin therapy might be protective against Candida colonization or infection in high-risk patients with type 2 diabetes, according to a new study.

Researchers at Massachusetts General Hospital (MGH; Boston, MA, USA) conducted a retrospective cohort study and analyzed the records of 1,019 patients with type 2 diabetes admitted for gastrointestinal surgery over an 8-month period. Of these, 48% had received statin therapy and 52% had not, with statin exposure defined as filling one or more statin prescriptions during the six months prior to or during hospitalization. Patients in the statin group were more likely to be older and less likely to be taking chemotherapeutic agents; however, there was no difference in antibiotic use between the two groups. The primary outcome was the incidence of Candida colonization or infection.

The researchers found that there were 139 incidents of Candida colonization or infection; of these, 56 events occurred in the statin group (40.3%) and 83 occurred in the nonstatin group (59.7%). After adjustment for confounders, the use of statins was associated with a 40% reduction in the development of Candida colonization. Independent predictors of Candida colonization or infection included central venous catheter, previous antibiotic use, intensive care unit stay, and length of hospital stay. Subanalysis showed that patients who discontinued statins during hospitalization were just as likely to have a decreased incidence of Candida colonization or infection. The effect of statins did not appear to be dose-dependent or associated with a particular statin type. The study results were presented at the American Association of Clinical Endocrinologists (AACE) annual meeting, held during April 2010 in Boston (MA, USA).

"Many times when patients are admitted to hospitals, statins are discontinued. We wanted to examine if this is a good practice,” said lead author and study presenter Elias Spanakis, M.D., of the division of infectious diseases at MGH. "We compared patients who were receiving statins prior to admission with a group of patients who were receiving statins both before and during hospitalization; we found no difference. So we conclude that the inhibition of Candida colonization and infection is a chronic effect of statins.”

Statins are used to lower plasma cholesterol level by inhibiting the enzyme HMG-CoA reductase, which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. This results in decreased cholesterol synthesis as well as increased synthesis of LDL receptors, resulting in an increased clearance of low-density lipoprotein (LDL) from the bloodstream.

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