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Melioidosis: Laboratory Investigations and Association with Patient Outcomes
ABSTRACT.
Melioidosis is an infection caused by the bacterium Burkholderia pseudomallei. The most common presentation is bacteremia occurring in 38–73% of all patients, and the mortality rate ranges from 9% to 42%. Although there is abundant data representing risk factors for infection and patient outcomes, there is limited information regarding laboratory investigations associated with bacteremia and mortality. We assessed a range of baseline and diagnostic investigations and their association with patient outcomes in a retrospective cohort study in Townsville, Australia. 124 patients’ medical and laboratory records were reviewed between January 1, 1997 and December 31, 2020. Twenty-seven patients died and 87 patients were bacteremic. The presence of lymphopenia (< 1.5 × 109 cells/L) was the highest risk for bacteremia (relative risk [RR] 2.2; 95% CI: 1.3–3.7, P < 0.001). Factors associated with mortality included lymphopenia, (RR: 1.4; 95% CI: 1.2–1.6, P = 0.004); uremia (RR: 1.7; 95% CI: 1.1–2.5, P = 0.03); and an elevated international normalized ratio (RR: 1.5; 95% CI: 1.2–2.0, P = 0.006). Median incubation to positive blood culture result was 28 hours with 15/82 (18%) positive in ≤ 24 hours. For serological testing during admission only 53/121 (44%) were indirect hemagglutination assay positive, 67/120 (56%) enzyme immunoassay IgG positive, and 23/89 (26%) IgM positive. Simple baseline investigations at time of presentation may be used to stratify patients at high risk for both bacteremia and mortality. This information can be used as a decision aid for early intensive management.
Author Notes
Authors’ addresses: Ian Gassiep, University of Queensland Centre for Clinical Research, Royal Brisbane and Woman’s Hospital, Herston, Queensland, Australia, and Department of Infectious Diseases, Mater Hospital Brisbane, South Brisbane, Queensland, Australia, E-mail: i.gassiep@uq.edu.au. Vibooshini Ganeshalingam, Department of Medicine, Townsville University Hospital, Townsville, Queensland, Australia, E-mail: vibooshini.ganeshalingam@health.qld.gov.au. Mark D. Chatfield, University of Queensland Centre for Clinical Research, Royal Brisbane and Woman’s Hospital, Herston, Queensland, Australia, E-mail: m.chatfield@uq.edu.au. Patrick N. A. Harris, University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia, and Pathology Queensland, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia, E-mail: p.harris@uq.edu.au. Robert E. Norton, Pathology Queensland, Townsville University Hospital, Townsville, Queensland, Australia, and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia, E-mail: robert.norton@health.qld.gov.au.