Selective statin therapy and nasal staphylococcal colonisation: a retrospective case-control study

Nasal Staphylococcus aureus (S. aureus) colonisation is a key risk factor for serious infections. Statins, used for hypercholesterolaemia and cardiovascular disease prevention, have been linked to gut microbiome dysbiosis, but their impact on nasal bacterial colonisation remains unclear.

To examine whether statin use, individual statins, and statin dose intensity are associated with nasal S. aureus colonisation, and whether associations differ between methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) colonisation.

A retrospective case-controlled study included 4,005 nasal swabs obtained from 3,983 patients at a tertiary hospital in Western Australia. Swabs were classified as S. aureus-positive (MRSA or MSSA); controls were negative. Statin exposure and dose intensity were assessed, and multivariable logistic regression adjusted for confounders.

Statin use was associated with increased odds of nasal S. aureus colonisation (OR 1.34; p < 0.001), driven by MSSA. Atorvastatin (OR 1.31; p = 0.005) and rosuvastatin (OR 1.56; p < 0.001) were independently associated with colonisation. A dose-response effect was observed: moderate-intensity (OR 1.26; p = 0.024) and high-intensity therapy (OR 1.47; p < 0.001) increased the odds of colonisation. MRSA showed no association. Diabetes was independently associated with S. aureus colonisation (OR 1.27; p = 0.004).

Statin therapy, particularly atorvastatin and rosuvastatin at moderate to high dose intensities, was associated with increased nasal S. aureus colonisation. These findings may have implications for infection prevention in high-risk patients, though they do not diminish the established cardiovascular benefits of statins. Prospective studies are required to confirm causality, elucidate mechanisms, and determine whether these findings should inform screening or decolonisation strategies.