Clinical characteristics and outcome of severe melioidosis requiring intensive care

Study objective: To describe the clinical characteristics and outcome of patients with severe melioidosis requiring intensive care. Design: Retrospective chart review. Setting: Two ICUs from a tertiary-care teaching hospital. Patients: Twenty-seven adult ICU patients with microbiologically documented melioidosis. Interventions: None. Measurements and results: The median age was 59 years with a male preponderance (26:1). Twenty patients (74%) had medical comorbidities, with diabetes mellitus being the most common (59.3%). Almost all patients (96.3%) were bacteremic. Twenty patients (74.1%) presented with pneumonia. Twenty patients (74.1%) were in septic shock, and 16 patients (59.3%) had ARDS. Twelve patients (44.4%) required hemodialysis. The patients had a median of three organ dysfunctions, and the median APACHE (acute physiology and chronic health evaluation) H score was 27. The overall mortality was 48.1%. Mortality among patients with septic shock was 60%. The median ICU length of stay for survivors and nonsurvivors was I I days and 2 days, respectively. Multivariate analysis revealed that the number of organ dysfunctions is an independent predictor of mortality (odds ratio, 8.2; 95% confidence interval, 1.3 to 51.4). Conclusions: The outcome of severe melioidosis requiring intensive care is poor, with death being predicted by the number of organ dysfunctions.