Do statins protect against the development of Clostridium difficile-associated diarrhoea?

OBJECTIVES To assess whether prior statin use protects against the development of Clostridium difficile-associated diarrhoea (CDAD) in hospitalized patients. PATIENTS AND METHODS A retrospective case-control study conducted in three hospitals included all hospitalized patients diagnosed with CDAD in the Internal Medicine Departments (IMDs) during a 1 year period. Subjects were determined to have CDAD if their stool sample was positive for C. difficile toxin in the context of diarrhoea at the time of diagnosis. Patients with CDAD were compared with patients without CDAD, hospitalized during the same period and in the same departments, matched for age, gender, comorbidities (Charlson score), length of hospitalization and antibiotic use during the last 3 months. RESULTS Prevalence of CDAD was 2.87% (197/6850 patients hospitalized in the IMDs). The 197 cases with CDAD were compared with 169 hospitalized patient controls. Sixty-four out of 197 (32.5%) patients in the CDAD group were statin users versus 87/169 (51.5%) of the controls (P = 0.02). Multivariate analysis showed that a Charlson score >3 [OR = 2.2 (95% CI 1.8-2.8), P = 0.024], chemotherapy during the last 6 months [OR = 3.09 (95% CI 1.95-3.91), P = 0.002], a history of intra-abdominal surgery [OR = 2.99 (95% CI 2.58-3.24), P = 0.003] and no statin use [OR = 2.2 (95% CI 1.82-2.73), P = 0.034] were associated with CDAD. CONCLUSIONS Prior statin use may provide protection against CDAD. Further studies are warranted to evaluate this association.