The Association Between Statin Therapy and the Subsequent Clinical Course of Patients With Melioidosis

Abstract

Background: Even in well-resourced settings, the case-fatality rate of melioidosis approaches 10%. This has prompted an interest in identifying adjunctive therapies that might improve survival. A prospective, multicentre study in Thailand suggested that statin therapy may reduce the incidence of pneumonia in patients with melioidosis; however, the impact of statins on the clinical course of patients with the infection is incompletely defined. Materials and Methods: We examined all cases of culture-confirmed melioidosis in Far North Queensland, tropical Australia, since October 2016 to determine if statin therapy influenced the clinical phenotype of melioidosis and the patients' clinical course. Results: Of 321 individuals with culture-confirmed melioidosis, 100 (31%) were prescribed a statin at the time of their diagnosis. There was no difference in the clinical phenotype of patients who were- and were not-taking statin therapy. Pulmonary involvement, specifically, was no less common in patients taking a statin (79/100 [79%] versus 175/221 [79%], p = 0.97). A smaller proportion of patients taking statin therapy died before hospital discharge, but this difference did not reach statistical significance (5/100 [5%] versus 26/221 [12%], p = 0.07). This finding was at least partially explained by the fact that fewer patients with an active malignancy were taking a statin (7/37 [19%] versus 93/284 [33%] patients without a malignancy, p = 0.09) and that, in multivariable analysis, patients with malignancy were more likely to die before hospital discharge (odds ratio [95% confidence interval]: 4.73 [1.62-13.87], p = 0.005). Among 290 individuals surviving to hospital discharge, there was no difference in 12-month mortality between those that were-and were not-prescribed a statin at presentation (11/95 [12%] versus 23/195 [12%], p = 0.96). Conclusion: Statin therapy does not appear to have any significant influence on the clinical phenotype of patients with melioidosis. There is also no appreciable impact of statin therapy on patients with melioidosis' short-term or 12-month survival.