RationaleHMG-CoA reductase inhibitor (statin) use is associated with a lower risk of incident pneumonia and, less robustly, with non-pulmonary infections. Whether statin use is associated with a lower risk of pneumonia compared to other clinical presentations of infection with the same pathogen is unknown.ObjectivesTo assess whether pre-admission statin use is associated with a lower risk of pneumonia compared to non-pneumonia presentations among patients hospitalized with Burkholderia pseudomallei infection (melioidosis).MethodsWe performed a secondary analysis of a prospective multicenter cohort study of patients hospitalized with culture-confirmed melioidosis. We used Poisson regression with robust standard errors to test for an association between statin use and pneumonia. We then performed several sensitivity analyses that addressed healthy user effect and indication bias.ResultsOf 1372 patients enrolled in the parent cohort, 1121 were analyzed. 980/1121 (87%) were statin nonusers and 141/1121 (13%) were statin users. 46/141 (33%) statin users presented with pneumonia compared with 432/980 (44%) of statin nonusers. Statin use was associated with a lower risk of pneumonia in unadjusted analysis (relative risk (RR) 0.74, 95% CI 0.58-0.95, p=0.02) and after adjustment for demographic variables, comorbidities, and environmental exposures (RR 0.73; 95% CI 0.57-0.94; p=0.02). Sensitivity analyses including active comparator analysis and inverse probability of treatment weighting were consistent with the primary analysis.ConclusionsIn hospitalized melioidosis patients, pre-admission statin use was associated with a lower risk of pneumonia compared with other clinical presentations of melioidosis, suggesting a lung-specific protective effect of statins.