Endemic melioidosis in tropical northern Australia: A 10-year prospective study and review of the literature

In a prospective study of melioidosis in northern Australia, 252 cases were found over 10 years. Of these, 46% were bacteremic, and 49 (19%) patients died. Despite administration of ceftazidime or carbapenems, mortality was 8 6% (43 of 50 patients) among those with septic shock. Pneumonia accounted f or 127 presentations (50%) and genitourinary infections for 37 (15%), with 35 men (18%) having prostatic abscesses. Other presentations included skin abscesses (32 patients; 13%), osteomyelitis and/or septic arthritis (9; 4%) , soft tissue abscesses (10; 4%), and encephalomyelitis (10; 4%). Risk fact ors included diabetes (37%), excessive alcohol intake (39%), chronic lung d isease (27%), chronic renal disease (10%), and consumption of kava (8%). On ly 1 death occurred among the 51 patients (20%) with no risk factors (relat ive risk, 0.08; 95% confidence interval, 0.01-0.58). Intensive therapy with ceftazidime or carbapenems, followed by at least 3 months of eradication t herapy with trimethoprim-sulfamethoxazole, was associated with decreased mo rtality. Strategies are needed to decrease the high mortality with melioido sis septic shock. Preliminary data on granulocyte colony-stimulating factor therapy are very encouraging.