T been able to adjust for other important explanatory/confounding variables

T been able to adjust for other important explanatory/confounding variables pertinent to infection risk [5,6], the weight of evidence suggests that patients with type 2 diabetes have an increased incidence of common communityacquired infections [7,8], 22948146 including lower respiratory tract infection, urinary tract infection (UTI), and skin and mucousmembrane infections [6]. There is also a substantially increased susceptibility to rare but potentially fatal infections including necrotizing fasciitis and emphysematous pyelonephritis [4,5]. In addition, diabetes has been identified as an independent risk factor for severe Gram positive blood stream infections [8?0], and for hospital-acquired post-operative bacterial infections [11,12]. Data from observational studies suggest that 3-hydroxy-3methyl-glutaryl-Coenzyme A reductase inhibitors (statins) may have beneficial effects on the prevention and treatment of bacterial infections in the general population [13?5]. However, a recent meta-analysis of randomized placebo-controlled trials found no effect of statin therapy on infection risk or infection-related death [16]. Statin therapy is commonly prescribed for patients with diabetes [17] who are also more susceptible to infection [7,8],Serious Bacterial Infections in Type 2 Diabetesfactors that could increase the likelihood of unmasking a beneficial effect of statins on infection risk. There would be difficulties in assessing this validly through a contemporary randomized trial, since there would be a relatively small group of eligible diabetic patients in whom vascular risk was low enough to ethically withhold statin therapy if they were allocated placebo. Observational studies, especially those conducted before evidence of statin cardiovascular benefit became available, are the best source of such comparative data. However, apart from one retrospective UK primary care study in which statin use was associated with a decreased risk of pneumonia [18], there have been no published data regarding the effect of statin therapy on the incidence of infections in diabetic patients. The aims of the present study were, therefore, to i) identify the incidence and predictors of bacterial infections severe enough to require hospitalization of representative community-based patients with type 2 diabetes, and ii) determine Fexinidazole whether statin therapy protects against pneumonia requiring hospitalization in a subset of type 2 patients.diogram [22]. Self-reported stroke and transient ischemic attack were amalgamated with prior hospitalizations to define baseline cerebrovascular disease status. Peripheral arterial disease (PAD) was considered to be present when the ankle brachial index (ABI) was #0.90 or there was a history of any PAD-related lower extremity amputation [23]. Additional endpoint data were obtained from a government register that records details of all deaths and all hospitalizations (whether to a public or private hospital) in the state of Western Australia (WA) and which is part of the larger WA Data Linkage System [24]. These sources provided details of hospital Clavulanic acid potassium salt chemical information inpatient admissions from the beginning of January 1993 until the end of December 2010.Selection of non-diabetic control subjectsIt is compulsory for all Australians aged 18 years to vote in Federal and State elections and thus all adults resident in the FDS1 catchment area are listed on the electoral roll. Four age-, sex- and zip-code-matched non-diabetic controls were randomly selected from.T been able to adjust for other important explanatory/confounding variables pertinent to infection risk [5,6], the weight of evidence suggests that patients with type 2 diabetes have an increased incidence of common communityacquired infections [7,8], 22948146 including lower respiratory tract infection, urinary tract infection (UTI), and skin and mucousmembrane infections [6]. There is also a substantially increased susceptibility to rare but potentially fatal infections including necrotizing fasciitis and emphysematous pyelonephritis [4,5]. In addition, diabetes has been identified as an independent risk factor for severe Gram positive blood stream infections [8?0], and for hospital-acquired post-operative bacterial infections [11,12]. Data from observational studies suggest that 3-hydroxy-3methyl-glutaryl-Coenzyme A reductase inhibitors (statins) may have beneficial effects on the prevention and treatment of bacterial infections in the general population [13?5]. However, a recent meta-analysis of randomized placebo-controlled trials found no effect of statin therapy on infection risk or infection-related death [16]. Statin therapy is commonly prescribed for patients with diabetes [17] who are also more susceptible to infection [7,8],Serious Bacterial Infections in Type 2 Diabetesfactors that could increase the likelihood of unmasking a beneficial effect of statins on infection risk. There would be difficulties in assessing this validly through a contemporary randomized trial, since there would be a relatively small group of eligible diabetic patients in whom vascular risk was low enough to ethically withhold statin therapy if they were allocated placebo. Observational studies, especially those conducted before evidence of statin cardiovascular benefit became available, are the best source of such comparative data. However, apart from one retrospective UK primary care study in which statin use was associated with a decreased risk of pneumonia [18], there have been no published data regarding the effect of statin therapy on the incidence of infections in diabetic patients. The aims of the present study were, therefore, to i) identify the incidence and predictors of bacterial infections severe enough to require hospitalization of representative community-based patients with type 2 diabetes, and ii) determine whether statin therapy protects against pneumonia requiring hospitalization in a subset of type 2 patients.diogram [22]. Self-reported stroke and transient ischemic attack were amalgamated with prior hospitalizations to define baseline cerebrovascular disease status. Peripheral arterial disease (PAD) was considered to be present when the ankle brachial index (ABI) was #0.90 or there was a history of any PAD-related lower extremity amputation [23]. Additional endpoint data were obtained from a government register that records details of all deaths and all hospitalizations (whether to a public or private hospital) in the state of Western Australia (WA) and which is part of the larger WA Data Linkage System [24]. These sources provided details of hospital inpatient admissions from the beginning of January 1993 until the end of December 2010.Selection of non-diabetic control subjectsIt is compulsory for all Australians aged 18 years to vote in Federal and State elections and thus all adults resident in the FDS1 catchment area are listed on the electoral roll. Four age-, sex- and zip-code-matched non-diabetic controls were randomly selected from.