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Statin use and the risk of Clostridium difficile in academic medical centres
  1. Christine Anne Motzkus-Feagans1,
  2. Amy Pakyz2,
  3. Ronald Polk2,
  4. Giovanni Gambassi3,
  5. Kate L Lapane1
  1. 1Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
  2. 2Department of Pharmacotherapy and Outcomes Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA
  3. 3Università Cattolica del Sacro Cuore, Rome, Italy
  1. Correspondence to Christine Anne Motzkus-Feagans, Department of Epidemiology and Community Health, Virginia Commonwealth University, School of Medicine, 830 E. Main Street, RM 5010, P.O. Box 980212, Richmond, VA 23298-0212, USA; motzkusca{at}


Objectives To estimate the possible relationship between statin use and the risk of healthcare facility onset Clostridium difficile.

Methods Patients over 18 years of age admitted to hospitals contributing data to the University HealthSystem Consortium between 2002 and 2009 were eligible. Patients with the ICD-9-CM code 008.45 who received a minimum 3-day course of either metronidazole or oral vancomycin on/after day 5 of admission were considered incident cases of C difficile infection. 31 472 incident cases of C difficile infection were identified and matched to five controls, on hospital, year/quarter of admission date, and age ±10 years (N=78 096). Patients who were administered one drug in the statin class (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin or simvastatin) before the index date were considered to be exposed. Conditional logistic regression modelling provided adjusted odds ratios and 95% CI.

Results Compared with non-users, users of any drug within the statin class were 0.78 times less likely to develop C difficile infection in the hospital (95% CI 0.75 to 0.81) adjusting for potential confounders. Differences in estimates for specific statins were minimal. Niacin, fibrates and selective cholesterol absorption inhibitors showed no association with the risk of C difficile infection.

Conclusions Our data were consistent with a growing body of literature demonstrating a reduced risk of infections with statin use. Statins' pleiotropic properties may provide protection against C difficile infection.

  • Clostridium difficile infection
  • epidemiology
  • statins

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  • Funding This study was supported in part by grant number UL1RR031990 and by grant number K08HS018578 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the agency for Healthcare Research and Quality. Neither funding source was involved in any part of the study.

  • Competing interests RP has received grant funding from Merck, Astellas and Cubist Pharmaceuticals. KLL has consulted for OrthoMcNiell Janssen Scientific Affairs on pain management in nursing homes. The other authors declare they have no competing interests.

  • Ethics approval Ethics approval was provided by the Virginia Commonwealth University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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