BOSTON (EGMN) – Statin therapy was associated with a significantly reduced risk for Candida colonization or infection in patients with type 2 diabetes who were undergoing gastrointestinal tract surgery.

Previous studies have suggested that statins can inhibit the growth of fungi by interfering with the ergosterol pathway. However, a retrospective cohort study of 1,019 patients with type 2 diabetes who underwent lower GI surgery is the first clinical study to investigate the effect, Dr. Ilias Spanakis said at the annual meeting of the American Association of Clinical Endocrinologists.

Statin exposure was defined as the filing of at least one prescription for statins during the 6 months prior to and/or during hospitalization. The primary outcome was the presence of any positive culture for Candida species during the hospitalization.

Of the total 1,019 patients who underwent the surgery between January 1, 2001 and May 1, 2008, 48% (493) received statin therapy and 52% (526) did not. Those with statin exposure were older (67.8 vs. 64.9 years, respectively), and had a higher modified Charleson comorbidity index.

A total of 139 patients developed Candida colonization or infection. After adjustment for major confounders, statin use was associated with a statistically significant 40% reduction in the development of Candida colonization or infection (odds ratio, 0.60). Other factors that were found to be independently associated with Candida colonization or infection included length of stay (OR, 1.05), intensive care unit length of stay (OR, 2.37), colonization of central venous catheters (OR, 3.15), and prior antibiotic use (OR, 2.98).

Statins were associated with reduced risk of Candida colonization or infection regardless of Charleson score, although there was a greater apparent benefit of statins in those with scores of 2 or higher, indicating more comorbidity. In that group, there was a 53% reduction in Candida colonization with statins, said Dr. Spanakis of Massachusetts General Hospital, Boston.

The effect of statin use on Candida colonization did not appear to differ by statin type or dose, although the numbers of each were small, he noted.

In an interview, Dr. Spanakis explained that statins inhibit ergosterol, an essential lipid component of fungal cell walls that is the primary target for antifungal agents including the polyenes and the azoles. Findings in many in vitro studies have suggested that statins can inhibit the growth of several Candida species.

“Candida colonization represents one of the most important factors for invasive candidiasis. Our results underline that exposure to statin therapy may decrease the incidence of Candida colonization or infection in high-risk hospitalized patients,” said Dr. Spanakis, noting that because this study was the first in the field, further studies are needed “to deepen knowledge in this issue.”

Dr. Spanakis said he had no financial disclosures. His coauthor, Dr. Eleftherios Mylonakis, has received research support from Astellas Pharma US Inc., and was a member of the speakers bureau for Pfizer Inc.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

波士顿(EGMN)——行胃肠道手术的2型糖尿病患者应用他汀类药物治疗与念珠菌定植或感染风险显著减少有关。

 

先前有研究表明，他汀类药物通过干扰麦角固醇途径，可以抑制真菌生长。但首项探讨此作用的临床研究是一项对1,019例行下消化道手术的2型糖尿病患者进行的回顾性队列研究，Ilias Spanakis博士在美国临床内分泌医师学会年会上说道。

 

应用他汀类药物的定义为在住院前6个月和(或)住院期间至少开过一张他汀类药物处方。主要结局为住院期间念珠菌属培养的任何阳性结果。

 

在总共1,019例于2001年1月1日~2008年5月1日期间行手术的患者中，有48%(493例)接受了他汀药物治疗，有52%(526例)没有接受他汀药物治疗。他汀类药物治疗者较年长(分别为67.8岁对 64.9 岁)且改良的Charleson共病指数(modified Charleson comorbidity index)较高。

 

总共139例患者发生念珠菌定植或感染。在对主要混杂因子进行校正后，应用他汀类药物仍与念珠菌定植或感染的发生显著减少40%有关(比值比为0.60)。发现的其他与念珠菌定植或感染有关的因素包括住院时间(比值比，1.05)、重症监护室内监护时间(比值比，2.37)、留置中心静脉输液针(比值比，3.15)以及既往抗生素用药史(比值比，2.98)。

 

他汀类药物与念珠菌定植或感染风险减少有关，无论Charleson评分如何，尽管对分值≥2(表示合并症较多)的患者应用他汀类药物有较明显的收益。在该组患者中，他汀类药物治疗使念珠菌定植减少53%，波士顿马萨诸塞州总医院的Spanakis博士说道。

 

他指出，应用他汀类药物对念珠菌定植的影响似乎与他汀类药物的类型或剂量无关，尽管各组的例数很少。

 

Spanakis博士在一次受访中解释说，他汀类药物可抑制麦角固醇，这是真菌细胞壁的主要脂质成分，细胞壁是多烯类及唑类等抗真菌药物的主要靶点。许多体外研究结果表明，他汀类药物可抑制多种念珠菌属生长。

 

“念珠菌定植是侵袭性念珠菌病的最重要因素之一。我们的结果强调应用他汀类药物治疗可能会降低高危住院患者中念珠菌定植或感染的发生率，”Spanakis博士说，并指出，由于本研究是该领域首项研究，故还需做进一步的研究“以加深对该问题的理解。”

 

Spanakis博士无财务披露。他的合著者Eleftherios Mylonakis博士已收到安斯泰来制药(美国)有限责任公司的研究资助，其本人亦为辉瑞公司讲师团成员。

 

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