Statins in candidemia: clinical outcomes from a matched cohort study.
Open accessAbstract
BACKGROUND: HMG CoA reductase inhibitors (statins) in patients with bacteremic sepsis have shown significant survival benefits in several studies. There is no data on the effect of statins in candidemic patients, however in-vitro models suggest that statins interfere with ergesterol formation in the wall of yeasts. METHODS: This retrospective matched- cohort study from 1/2003 to 12/2006 evaluated the effects of statins on patients with candidemia within intensive care units. Statin-users had candidemia as a cause of their systemic inflammatory response and were on statins throughout their antifungal therapy, while non-statin users were matched based on age +/- 5 years and co-morbid factors. Primary analysis was 30-day survival or discharge using bivariable comparisons. Multivariable comparisons were completed using conditional logistic regression. All variables with a p-value less than 0.10 in the bivariable comparisons were considered for inclusion in the conditional logistic model. RESULTS: There were 15 statin-users and 30 non-statin users that met inclusion criteria, all with similar demographics and co-morbid conditions except the statin group had more coronary artery disease (P < 0.01) and peripheral vascular disease (P = 0.03) and lower median APCAHE II scores (14.6 vs 17, p = 0.03). There were no differences in duration of candidemia, antifungal therapy or Candida species between the groups. Statins were associated with lower mortality on bivariable (OR 0.09, 95% CI 0.11-0.75, p = 0.03) and multivariable (OR 0.22, 95% CI 0.02-2.4, p = 0.21) analyses compared to controls; although, in the latter the protective effect lacked statistical significance. CONCLUSION: In our small, single-center matched-cohort study, statins may provide a survival benefit in candidemia, however further studies are warranted to validate and further explore this association.
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Statins inhibit HMG-CoA reductase, and their antimicrobial activity is thought to stem from inhibition of isoprenoid biosynthesis, disrupting ergosterol biosynthesis, G-protein signaling, and Ras-dependent pathways.
“Statins act as inhibitors of hydroxymethylglutaryl‐CoA (HMG‐CoA) reductase, and their antimicrobial activity is thought to stem from the inhibition of isoprenoid biosynthesis, thereby disrupting key processes in fungal physiology, including ergosterol biosynthesis, modulation of G‐protein signaling, and activation of Ras‐dependent pathways [18, 19].”
From Statins as Antifungal Agents: A Review on Drug Repurposing and Nanotechnology-Driven Delivery Strategies (2025) · cites this paper as [18]
The Background identifies statins as HMG-CoA reductase inhibitors and says yeast produce ergosterol rather than cholesterol. The Discussion reports in-vitro evidence suggesting statins interfere with yeast ergosterol production. Neither section attributes their antimicrobial activity specifically to inhibition of isoprenoid biosynthesis or discusses G-protein signaling or Ras-dependent pathways. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPravastatin enhanced survival and led to a decreased fungal burden in C3H/HeN mice infected with C. albicans.
“other work has demonstrated that pravastatin enhanced survival and led to a decreased fungal burden in C3H/HeN mice infected with C. albicans and the potential benefits of statins in the clinic against Candida have been described [10, 40-42].”
From Assessment of the in vitro and in vivo activity of atorvastatin against Candida albicans. (2019) · cites this paper as [42]
The Methods and Results describe a matched cohort of human ICU patients with candidemia, not infected mice. Searches for C3H/HeN mice, pravastatin, and fungal burden found no passage reporting the claimed mouse survival or fungal-burden results. The paper addresses the separate clinical-benefits clause in the citing sentence, but that does not verify the quoted mouse claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSome studies have described potential benefits for statin use during Candida infection in mice and in a clinical setting.
“Although some studies have described potential benefits for statin use during a Candida infection both in mice (Tashiro et al., 2012) and in a clinical setting (Forrest et al., 2010; Spanakis et al., 2010; Cuervo et al., 2013)”
From Atorvastatin Reduces the Survival of Candida albicans-Infected BALB/c Mice (2015) · cites this paper as Forrest et al., 2010
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- Authors
- Forrest, G. N., Kopack, A. M., & Perencevich, E. N.
- Affiliations
- Oregon Health & Science University (US)
- University of Iowa (US)
- Corresponding author
- Forrest, Graeme N
- Venue
- BMC Infectious Diseases
- Published
- 2010-06-04
- Volume
- 10
- Issue
- 1
- Pages
- 152-152
- ISSN
- 1471-2334 (ISSN-L)
- PMC
- PMC2894022
- OpenAlex
- W2069028204
- Cited by
- 33
- References
- 30
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 1 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 1 · 2015: 4 · 2014: 4 · 2013: 6 · 2012: 2
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- statins, candidemia, intensive care unit patients, antifungal therapy, ergosterol biosynthesis, systemic inflammatory response syndrome, coronary artery disease, peripheral vascular disease
- MeSH terms
- Aged, Anticholesteremic Agents, Antifungal Agents, Candidiasis, Female, Humans, Intensive Care Units, Male, Middle Aged, Retrospective Studies, Time Factors, Cohort Studies, Case-Control Studies, Fungemia, Treatment Outcome, APACHE
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