Characteristics, clinical outcomes and factors influencing mortality of patients with melioidosis in southern Thailand: a 10-year retrospective study

Objective: To study characteristics, clinical outcomes and factors influencing mortality of patients afflicted with melioidosis. Methods: A total of 134 patients were retrospectively analyzed with a microbiologically-confirmed diagnosis of melioidosis, during the period from January 2002 to June 2011 at Songklanagarind Hospital, a tertiary care hospital in southern Thailand. Results: The prevalence of melioidosis among admitted patients was 36.8 per 100 000 in patients. The median age was 49 years and they were predominantly male. The most common underlying disease was diabetes mellitus (47.01%). The majority of cases (50%) had localized infection. The rates of multifocal, bacteremic, and disseminated infections were 12.7%, 23.1%, and 14.2%, respectively. The lungs were the most common organ afflicted, resulting in infection (24.63%). Splenic abscess as well as liver abscess accounted for 20.90% and 19.40%, respectively. A total of one eighth of the patients had septic shock at presentation. The overall mortality rate was 8.96%. The factors influencing mortality were pneumonia, septic shock, a positive blood culture for Burkholderia pseudomallei, superimposing with nosocomial infection and inappropriate antibiotic administration. Conclusions: Melioidosis is not uncommon in southern Thailand. The mortality of patients with pneumonia, bacteremia and septic shock is relatively high. Appropriate antibiotics, initially, will improve outcomes.