Prideaux Laura, Stratton Hayley, Sandeman Meg, Smith Simon, Hanson Josh
Department of Medicine, Cairns Hospital, Cairns 4870, Queensland, Australia.
The Kirby Institute, University of New South Wales, Kensington 2033, New South Wales, Australia.
J Trop Med. 2025 May 25;2025:8838580. doi: 10.1155/jotm/8838580. eCollection 2025.
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. 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. 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%], = 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%], = 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, = 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], = 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%], = 0.96). 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.
即使在资源充足的环境中，类鼻疽的病死率也接近10%。这引发了人们对确定可能改善生存率的辅助治疗方法的兴趣。泰国的一项前瞻性多中心研究表明，他汀类药物治疗可能会降低类鼻疽患者肺炎的发病率；然而，他汀类药物对感染患者临床病程的影响尚未完全明确。我们调查了自2016年10月以来澳大利亚热带地区昆士兰远北地区所有经培养确诊的类鼻疽病例，以确定他汀类药物治疗是否会影响类鼻疽的临床表型和患者的临床病程。在321例经培养确诊的类鼻疽患者中，100例（31%）在诊断时使用了他汀类药物。接受和未接受他汀类药物治疗的患者临床表型没有差异。具体而言，肺部受累在服用他汀类药物的患者中同样常见（79/100 [79%] 对比175/221 [79%]，P = 0.97）。接受他汀类药物治疗的患者在出院前死亡的比例较小，但这种差异未达到统计学意义（5/100 [5%] 对比26/221 [12%]，P = 0.07）。这一发现至少部分可以解释为，患有活动性恶性肿瘤的患者服用他汀类药物的较少（7/37 [19%] 对比无恶性肿瘤的患者93/284 [33%]，P = 0.09），并且在多变量分析中，患有恶性肿瘤的患者在出院前死亡的可能性更大（比值比 [95% 置信区间]：4.73 [1.62 - 13.87]，P = 0.005）。在290例存活至出院的患者中，入院时接受和未接受他汀类药物治疗的患者12个月死亡率没有差异（11/95 [12%] 对比23/195 [12%]，P = 0.96）。他汀类药物治疗似乎对类鼻疽患者的临床表型没有任何显著影响。他汀类药物治疗对类鼻疽患者的短期或12个月生存率也没有明显影响。
