Case Report: Risk Factors Associated with Mortality in Adults with Burkholderia Pseudomallei Bacteremia: A Retrospective Case Series of Melioidosis in Cambodia

Andrea R. Pacheco International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Sophana Chea International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Helena Saunders Department of Psychology, Colorado College, Colorado Springs, Colorado;

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Sokna Ly International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Ratanak Sath International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Rathna Tim International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Sreyngim Lay International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;
National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia;

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Mengheng Oum International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Gechlang Tang International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Lyhourng Long International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Sovann Ly Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia;

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Heng Seng Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia;

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Sidonn Krang Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia;

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Chhouv Chhuon Takeo Provincial Referral Hospital, Takeo, Cambodia;

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Vantha Te Takeo Provincial Referral Hospital, Takeo, Cambodia;

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Sosorphea Seang Takeo Provincial Referral Hospital, Takeo, Cambodia;

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Chanthap Lon International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;

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Christina Yek Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland;
Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland

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Jessica E. Manning International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia;
Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, Maryland

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In resource-scarce settings, melioidosis is associated with up to 80% mortality. Studies of melioidosis in Cambodia report primarily on pediatric populations with localized infection; however, literature describing Cambodian adults with severe melioidosis is lacking. We present a case series of 35 adults with sequence-confirmed Burkholderia pseudomallei bacteremia presenting to a provincial referral hospital in rural Cambodia. More than 90% of the patients had diabetes, an important risk factor for developing melioidosis. Inappropriate antimicrobial therapy was significantly associated with lower odds of survival. Improved diagnostic testing and greater access to first-line antibiotics for acute melioidosis treatment present potential targets for intervention to reduce mortality associated with this disease in resource-limited settings.

Author Notes

Financial support: This work was supported by the Division of Intramural Research at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and the Bill and Melinda Gates Foundation (grant no. INV-028123 to J. E. Manning).

Disclosure: Anonymized clinical data and bacterial genomic data are available upon request.

Authors’ contributions: C. Yek, C. Lon, and J. E. Manning designed the study. C. Chhuon, V. Te, and S. Seang oversaw patient management and microbiology testing. S. Ly, R. Sath, and R. Tim collected patient data. S. Chea, S. Lay, M. Oum, G. Tang, and L. Long sequenced blood culture isolates. The study was supervised by C. Lon and J. E. Manning and coordinated by S. V. Ly, H. Seng, and S. Krang. Data extraction and curation were done by A. R. Pacheco, H. Saunders, S. Chea, C. Yek, and C. Lon. A. R. Pacheco analyzed the data. A. R. Pacheco, C. Yek, and J. E. Manning prepared the original draft. All authors reviewed and edited the manuscript before submission.

Authors’ addresses: Andrea R. Pacheco, University of Miami Leonard M. Miller School of Medicine, Miami, FL, E-mail: arp2170@columbia.edu. Sophana Chea, Sokna Ly, Ratanak Sath, Rathna Tim, Mengheng Oum, Gechlang Tang, Lyhourng Long, and Chanthap Lon, International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia, E-mails: cheas@icercambodia.org, lys@icercambodia.org, sratanak@icercambodia.org, rathnat@icercambodia.org, hengo@icercambodia.org, gechlangt@icercambodia.org, lyhournglong@icercambodia.org, and lonc@icercambodia.org. Helena Saunders, Department of Psychology, Colorado College, Colorado Springs, CO, E-mail: l_saunders@coloradocollege.edu. Sreyngim Lay, International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia, and National Center of Parasitology, Entomology, and Malaria Control, Phnom Penh, Cambodia, E-mail: lays@icercambodia.org. Sovann Ly, Heng Seng, and Sidonn Krang, Communicable Disease Control Department, Ministry of Health, Phnom Penh, Cambodia, E-mails: sovann_ly@yahoo.com, hengcdc@gmail.com, and sidonnkrang@yahoo.com. Chhouv Chhuon, Takeo Provincial Referral Hospital, Takeo, Cambodia, E-mail: chhouvchhuon@yahoo.com. Vantha Te and Sosorphea Seang, Takeo Provincial Referral Hospital, Takeo, Cambodia, E-mails: pediatrh@yahoo.com and sosorpheaseang@gmail.com. Christina Yek, Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD, and Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, E-mail: christina.yek@nih.gov. Jessica E. Manning, Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Rockville, MD, and International Center of Excellence in Research, National Institute of Allergy and Infectious Diseases, Phnom Penh, Cambodia, E-mail: jessica.manning@nih.gov.

Address correspondence to Christina Yek, 1 Christopher Howes Place, Phnom Penh, Cambodia 120211. E-mail: christina.yek@nih.gov
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