스타틴 약물이 Clostridium difficile 연관 감염의 임상경과에 미치는 영향 분석

Abstract

배경: 패혈증을 포함한 감염성 질환의 치료 반응에 대한 스타틴의 효과는 여러 연구에서 입증된 바 있다. 목적: 본 연구에서는 스타틴이 Clostridium difficile (C. difficile) 감염의 임상 경과에 미치는 영향에 대하여 분석하고자 한다. 방법: Toxin assay (A or B)에 양성, C. difficile 배양결과 양성 혹은 하부위장관 내시경검사에서 위막성대장염이 진단된 949명의 환자의 의무기록을 후향 분석하였다. 이 중 치료시작 6일이내 증상(설사)이 회복되었을 경우 치료 성공으로 정의하였다. 일차평가항목은 평균 증상 회복 시간과 성공/ 실패로 분류한 치료 반응 비율로 정하였다. 결과: 총 949명의 환자 중 metronidazole 치료의 성공율은 91.9%였다. Statin에 노출된 군과 노출되지 않은 군 사이에 질병 중등도를 포함한 몇 가지 임상요인에서 유의한 차이를 보였다. 성공적인 치료 반응에 대한 다변량 분석에서 PPI에 노출됨과 statin에 노출됨을 각각 유의한 차이를 보였다. (OR = 0.690, 95% CI = 0.513–0.929, P = 0.014 및 OR = 1.449, 95% CI = 1.015–2.070, P = 0.041) 치료 반응과는 다르게 타 약제의 노출력은 증상회복시간과는 무관하게 나타났다. 또한 Statin에 노출된 군과 노출되지 않은 군 사이에 60일 재발율은 유의한 차이를 보였으나 30일 사망률이나 중증합병증의 발병율에서는 차이를 보이지 않았다. 결론: 스타틴 약물에 노출된 C. difficile 감염 환자는 그렇지 않은 환자와 비교하여 증상회복이 빨랐으며 높은 치료 성공율을 보였다. |Background There is an association between exposure to statin and favor treatment outcome for various infection. Aim To determine the clinical characteristics and treatment outcomes of Clostridium difficile (C. difficile) infection (CDI) among inpatients taking statins Methods We reviewed the medical records of consecutive inpatients with CDI We defined treatment success as diarrhea resolution within 6 days of therapy. The primary endpoints were assessed by average symptom recovery time and treatment response categorized as success or failure. Results Among 949 evaluable patients, the overall response to metronidazole was 91.9%. The baseline characteristics showed some differences between the statin users group and statin non-users group with regard to mean disease severity score. In multivariate analysis, successful treatment response was significantly associated with the absence of exposure to PPI (OR = 0.690, 95% CI = 0.513–0.929, P = 0.014) and the presence of exposure to statin (OR = 1.449, 95% CI = 1.015–2.070, P = 0.041). Contrary to treatment response, exposure to PPI or statin did not affect symptom recovery time. Sixty-days CDI recurrence rates for those with statin exposure revealed significantly lower than those without statin exposure (7.3% vs 3%; RR = 0.393, 95% CI = 0.167–0.926, P = 0.033). Conclusions Prior statin exposure in patients with CDI is associated with improvement in clinical course as it relates to treatment response.; Background There is an association between exposure to statin and favor treatment outcome for various infection. Aim To determine the clinical characteristics and treatment outcomes of Clostridium difficile (C. difficile) infection (CDI) among inpatients taking statins Methods We reviewed the medical records of consecutive inpatients with CDI We defined treatment success as diarrhea resolution within 6 days of therapy. The primary endpoints were assessed by average symptom recovery time and treatment response categorized as success or failure. Results Among 949 evaluable patients, the overall response to metronidazole was 91.9%. The baseline characteristics showed some differences between the statin users group and statin non-users group with regard to mean disease severity score. In multivariate analysis, successful treatment response was significantly associated with the absence of exposure to PPI (OR = 0.690, 95% CI = 0.513–0.929, P = 0.014) and the presence of exposure to statin (OR = 1.449, 95% CI = 1.015–2.070, P = 0.041). Contrary to treatment response, exposure to PPI or statin did not affect symptom recovery time. Sixty-days CDI recurrence rates for those with statin exposure revealed significantly lower than those without statin exposure (7.3% vs 3%