A sequence symmetry analysis of the interrelationships between statins, diabetes and skin infections.
AIMS
To determine statins' impact on skin infection risk in view of conflicting literature: that statins may reduce infection risk, but are also associated with diabetes mellitus, a risk factor for skin and soft tissue infections (SSTIs).


METHODS
Sequence symmetry analysis was performed on prescription claims (2001-2011) from the Australian Department of Veterans' Affairs to determine the interrelationships between: (i) statins and SSTIs; (ii) statins and diabetes; and (iii) diabetes and SSTIs; as well as whether statins increased the risk of SSTIs, independent of diabetes status. Chi-square tests were performed to detect differences in Index of Relative Socio-economic Advantage and Disadvantage scores of patients within each interrelationship. Prescriptions for statins, antidiabetic medication, and antistaphylococcal antibiotics were evaluated using nonidentifiable client numbers, prescription dates filled, residential electorates, and pharmaceutical codes. Adjusted sequence ratio and confidence interval were calculated at intervals of 91, 182 and 365 days for sequence symmetry analysis studies.


RESULTS
Statins were associated with: (i) significant SSTI risk (adjusted sequence ratio > 1; confidence interval >1), (ii) significant diabetes risk, and (iii) diabetic patients had increased risk of SSTIs. Diabetic and nondiabetic statin users had significantly increased risks of SSTIs, while the influence from socioeconomic status was not significant for each of the 3 relationships.


CONCLUSIONS
Statins are associated with increased risk of SSTIs via direct and indirect mechanisms, probably independent of diabetes or socioeconomic statuses. We believe that clinicians should be aware of the association between statins and SSTIs, and, where appropriate, monitor blood glucose levels of statin users.
['Ko|Humphrey H T|HHT|0000-0003-3107-4240', 'Lareu|Ricky R|RR|', 'Dix|Brett R|BR|', 'Hughes|Jeffery D|JD|', 'Parsons|Richard W|RW|']
D000328:Adult D000368:Aged D001315:Australia D002318:Cardiovascular Diseases D003920:Diabetes Mellitus D011307:Drug Prescriptions D005260:Female D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D007113:Immunity, Innate D008297:Male D008875:Middle Aged D017891:Pharmacoepidemiology D012307:Risk Factors D012923:Social Class D013207:Staphylococcal Skin Infections D013211:Staphylococcus aureus
statins diabetes antibiotics pharmacoepidemiology