title: Melioidosis Causing Critical Illness: A Review of 24 Years of Experience From the Royal Darwin Hospital ICU.
abstract: Melioidosis is increasing in incidence with newly recognized foci of melioidosis in the Americas, Africa, and elsewhere. This review describes the demographics, management, and outcomes of a large cohort of critically ill patients with melioidosis.
  
  
  
  Data were extracted from two prospective databases-the Menzies School of Health Research Melioidosis Database (1989-2013) and the Royal Darwin Hospital ICU Melioidosis Database (2001-2013).
  
  
  
  The Royal Darwin Hospital ICU is the only ICU in the tropical Top End of Northern Territory of Australia, an endemic area for melioidosis. The study included all patients with melioidosis admitted to Royal Darwin Hospital ICU from 1989 to 2013.
  
  
  
  From 1989 to 2013, 207 patients with melioidosis required admission to ICU. Mortality reduced from 92% (1989-1997) to 26% (1998-2013) (p < 0.001). The reduced mortality coincided with the introduction of an intensivist-led service, meropenem, and adjuvant granulocyte colony-stimulating factor for confirmed melioidosis sepsis in 1998. Pneumonia was the presenting illness in 155 of 207 (75%). ICU melioidosis patients (2001-2013) had an Acute Physiology and Chronic Health Evaluation II score of 23, median length of stay in the ICU of 7 days, and median ventilation hours of 130 and one third required renal replacement therapy.
  
  
  
  The mortality for critically ill patients with melioidosis in the Top End of the Northern Territory of Australia has substantially reduced over the past 24 years. The reduction in mortality coincided with the introduction of an intensivist-led model of care, the empiric use of meropenem, and adjunctive treatment with granulocyte colony-stimulating factor in 1998.
authors.affiliation: 1Department of Intensive Care, Royal Darwin Hospital, Darwin, NT, Australia. 2Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. 3Department of Infectious Diseases and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, NT, Australia.
authors.forename: Dianne P
authors.initials: DP
authors.lastname: Stephens
authors.forename: Jane H
authors.initials: JH
authors.lastname: Thomas
authors.forename: Linda M
authors.initials: LM
authors.lastname: Ward
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
mesh_terms: D018806:APACHE; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008554:Melioidosis / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D000077731:Meropenem; D008875:Middle Aged; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013845:Thienamycins / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D016179:Granulocyte Colony-Stimulating Factor; D000077731:Meropenem