Relapse in melioidosis: incidence and risk factors.
From 1986 to 1991, 602 patients with melioidosis were seen in Sappasitprasong Hospital, Ubon Ratchatani, Thailand. The in-hospital mortality was 42%. Of 118 adult patients followed long-term, 27 (23%) had culture-proven relapses of melioidosis (3 relapsed twice), a relapse rate of 15% (95% confidence interval [CI], 11-22) per year. The median time from discharge to relapse was 21 weeks (range, 1-290). In 44% of patients, relapses included septicemia, and 27% died. Patients with severe disease (multiple foci of infection or septicemia) relapsed 4.7 times (95% CI, 1.6-14.1) more frequently than patients with localized melioidosis. Underlying disease was not a risk factor, but initial parenteral treatment with ceftazidime reduced the risk of relapse 2-fold (95% CI, 1.1-3.4). Relapses were 3.3 (95% CI, 1.4-9.0) times more frequent following short-course (< or = 8 weeks) oral coamoxiclav than after the oral combination regimen of chloramphenicol, doxycycline, and cotrimoxazole. Longer oral treatment with either reduced relapse 1.6-fold (95% CI, 1.2-1.9). The optimum choice and duration of antibiotic treatment to prevent relapse in melioidosis remain to be determined.
Chaowagul
W
W
Department of Medicine, Sappasitprasong Hospital, Ubon Ratchatani, Thailand.
Suputtamongkol
Y
Y
Dance
D A
DA
Rajchanuvong
A
A
Pattara-arechachai
J
J
White
N J
NJ
D000293:Adolescent; D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D019980:Amoxicillin-Potassium Clavulanate Combination; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002442:Ceftazidime / Q000627:therapeutic use; D002701:Chloramphenicol / Q000627:therapeutic use; D002969:Clavulanic Acids / Q000627:therapeutic use; D004318:Doxycycline / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D002969:Clavulanic Acids; D004338:Drug Combinations; D002701:Chloramphenicol; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002442:Ceftazidime; D004318:Doxycycline