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Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience
Author(s) -
Toh Valerie,
Tee Sui Poh,
Lee ShenHan
Publication year - 2021
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13563
Subject(s) - melioidosis , medicine , burkholderia pseudomallei , septic shock , pneumonia , univariate analysis , epidemiology , mortality rate , gastroenterology , surgery , intensive care medicine , sepsis , multivariate analysis , pathology , biology , genetics , bacteria
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.