Statin Use Associated With a Decreased Risk of Community-Acquired Staphylococcus aureus Bacteremia/In Reply

Interestingly, a recent study by Plotkin and Konakieva3 found that steroid hormones with the 3-hydroxy moiety (eg, cholesterol and estradiol) increased carotenoid levels in S aureus, which potentially increases bacterial virulence.4 Patients with chronic kidney disease usually have low levels of sex steroid hormones,5 but high levels of estradiol may present in septic patients.6 Knowledge of the antibiotic treatment outcomes for patients with chronic kidney who have CA-SAB and are statin users, compared with nonusers, might provide clues as to whether statins could offer additional benefits by suppressing the antagonistic precursor cholesterol molecule and downstream steroidal hormones sufficiently, resulting in efficacious antibiotic therapy. Because statins may induce newonset diabetes and the colonization of skin and mucosae with S aureus predisposes diabetic patients to infections,7,8 statin users with diabetes might be expected to have a higher risk of CASAB. Howe K, Sanat F, Thumser AE, Coleman T, Plant N. The statin class of HMG-CoA reductase inhibitors demonstrate differential activation of the nuclear receptors PXR, CAR and FXR, as well as their downstream target genes. Xenobiotica. 2011;41(7):519-529. https://doi.org/10.1016/j.mayocp.2017.12.024 In Reply-Statin Use Associated With a Decreased Risk of Community-Acquired Staphylococcus aureus Bacteremia We appreciate Dr Ko and colleagues' interesting reflections on our findings concerning the influence of statin use on the risk of communityacquired Staphylococcus aureus bacteremia (CA-SAB). Because the aim of our study was to provide epidemiological in vivo data on this association, Ko and colleagues' review of the literature and considerations on the potential underlying pathophysiologic mechanisms constitute a very valuable supplement to our paper.