title: Repeat blood culture positive for B. pseudomallei indicates an increased risk of death from melioidosis.
abstract: Melioidosis, a bacterial infection caused by Burkholderia pseudomallei, is notoriously difficult to cure despite appropriate antimicrobial therapy and has a mortality rate of up to 40%. We demonstrate that a blood culture positive for B. pseudomallei taken at the end of the first and/or second week after hospitalization for melioidosis is a strong prognostic factor for death (adjusted odds ratio = 4.2, 95% confidence interval = 2.1-8.7, P < 0.001 and adjusted odds ratio = 2.6, 95% confidence interval = 1.1-6.0, P = 0.03, respectively). However, repeat cultures of respiratory secretions, urine, throat swabs, or pus/surface swabs provide no prognostic information. This finding highlights the need for follow-up blood cultures in patients with melioidosis.
authors.affiliation: Department of Tropical Hygiene, Department of Microbiology and Immunology and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, Bangkok, Thailand. direk@tropmedres.ac
authors.forename: Direk
authors.initials: D
authors.lastname: Limmathurotsakul
authors.forename: Vanaporn
authors.initials: V
authors.lastname: Wuthiekanun
authors.forename: Gumphol
authors.initials: G
authors.lastname: Wongsuvan
authors.forename: Sukanya
authors.initials: S
authors.lastname: Pangmee
authors.forename: Premjit
authors.initials: P
authors.lastname: Amornchai
authors.forename: Prapit
authors.initials: P
authors.lastname: Teparrakkul
authors.forename: Nittaya
authors.initials: N
authors.lastname: Teerawattanasook
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D000293:Adolescent; D000328:Adult; D016957:Burkholderia pseudomallei / Q000302:isolation & purification* / Q000472:pathogenicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008554:Melioidosis / Q000097:blood* / Q000175:diagnosis* / Q000382:microbiology / Q000401:mortality*; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D013183:Sputum / Q000382:microbiology; D013492:Suppuration / Q000382:microbiology