Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience

Published in Tropical Medicine & International Health, 2021

Valerie Toh 1,2,*, Sui Poh Tee 1,3, Shen-Han Lee 4

1 Department of Medicine, Kapit Hospital, Sarawak, Malaysia.
2 Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
3 Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
4 Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Kedah, Malaysia.
*Corresponding author: valerietohwenting@gmail.com

Objectives: Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak.

Methods: For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality.

Results: Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P < 0.05). Multivariate analysis revealed that low serum bicarbonate (P = 0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P = 0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality.

Conclusion: Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.

Keywords: Burkholderia pseudomallei; Sarawak; melioidosis; predictive value of tests; retrospective; risk factors.

Copyright © 2021 John Wiley & Sons Ltd.

DOI: 10.1111/tmi.13563

Recommended citation: Toh V, Tee SP, Lee SH. (2021). "Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience." Tropical Medicine & International Health. 26(6):664-671.
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