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Summary Background Evidence about the beneficial effects of statins on reducing infections is accumulating. Identifying ways to reduce infection risk in patients with cirrhosis is important because of increased mortality risk and costs associated with infections. Aim To estimate the extent to which statin use prolongs time to infection among patients with cirrhosis. Methods We identified Veterans with cirrhosis, but without decompensation (n = 19 379) using US Veterans Health Administration data from 2001 to 2009. New users of statins were identified and propensity matched to non-users and users of other cholesterol-lowering medications (1:1 matching). The cohort was followed up for hospitalisations with infections. Cox regression models with time-varying exposures provided estimates of adjusted hazard ratios (HR) and 95% confidence intervals (CI). Results New statin use was present among 13% of VA patients with cirrhosis without decompensation. Overall, 12.4% of patients developed a serious infection, and 0.1% of patients died. In the propensity-matched sample, statin users experienced hospitalisations with infections at a rate 0.67 less than non-users (95% Confidence Interval: 0.47–0.95). Conclusions Infections are a major concern among cirrhotic patients and have the potential to seriously impact both life expectancy and quality of life. Statin use may potentially reduce the risk of infections among patients with cirrhosis.

Study Objectives To determine the proportion of hospitalized adults with hospital-onset Clostridium difficile infection (CDI) who continued to receive concomitant non-CDI antibacterial agents, to characterize the antibacterial therapy that these patients received before and after the diagnosis of CDI, and to compare hospital outcomes between those patients who did and those who did not have their previous antibacterial therapy discontinued after CDI diagnosis. Design Retrospective cohort study. Data Source Drug use and administrative discharge data from 42 United States academic medical centers. Patients A total of 5968 adult inpatients with hospital-onset CDI between January 1, 2002, and June 30, 2006. Measurements and Main Results We characterized patient-level antibacterial agent use before and after CDI diagnosis. Overall, 3479 patients (58.3%) continued antibacterial therapy for 2 or more days after CDI diagnosis (interhospital range 6.7–72.2%). Although the number of different antibacterial agents received in the week preceding CDI diagnosis was positively associated with continued antibacterial therapy, the relationship between continuation and severity of illness was statistically significant but nonlinear. Patients who were receiving oral vancomycin alone were less likely to have antibacterial therapy continued (28/61 patients [45.9%]) than patients receiving metronidazole alone (1154/2333 patients [49.5%]) or receiving both metronidazole and oral vancomycin (2297/3576 [64.2%]). After adjusting for confounders, patients who continued to receive antibacterial therapy had a 62.7% (95% confidence interval [CI] 48.6–78.0%, p

Hospital antibiograms are commonly used to help guide empiric antimicrobial treatment and are an important component of detecting and monitoring trends in antimicrobial resistance. To serve these purposes, antibiograms must be constructed using standardized methods that allow inter- and intrahospital comparisons. Antibiograms that include surveillance cultures and duplicate bacterial isolates can overestimate rates of resistance. In 2002, the National Committee for Clinical Laboratory Standards (now known as the Clinical and Laboratory Standards Institute [CLSI]) published standards for constructing antibiograms. According to national surveys, many of the recommended elements of the CLSI document have not been fully adopted. In lieu of full compliance with CLSI standards, it is necessary that the methods used to construct antibiograms are clearly delineated. Antibiograms have several limitations, such as their inability to track emergence of resistance during therapy. The antibiogram can serve as a valuable tool in guiding antimicrobial therapy, but other patient factors, such as previous infection history and antibiotic use, also need to be considered. Additional data are needed for specialized applications of resistance analyses.