Department of Medicine, Kapit Hospital, Sarawak, Malaysia.
Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia.
Trop Med Int Health. 2021 Jun;26(6):664-671. doi: 10.1111/tmi.13563. Epub 2021 Mar 3.
Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak.
For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality.
Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P < 0.05). Multivariate analysis revealed that low serum bicarbonate (P = 0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P = 0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality.
Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.
类鼻疽病由类鼻疽伯克霍尔德菌引起，在马来西亚农村地区流行。本研究旨在描述砂拉越卡皮地区类鼻疽病的流行病学和死亡预测因素。
本回顾性研究纳入了 2016 年 7 月至 2019 年 7 月期间在马来西亚砂拉越卡皮医院住院的培养确诊为类鼻疽病的患者，收集了流行病学、临床和微生物学数据。采用单变量和多变量逻辑回归分析来确定死亡的预测因素。
73 名患者符合纳入标准。糖尿病（28.8%）和高血压（27.4%）是主要合并症。类鼻疽病的临床谱从菌血症（64.4%）、肺炎（61.6%）和内脏脓肿（49.3%）到局部软组织（21.9%）和关节脓肿（6.9%）不等。死亡率为 12.3%。菌血症和肺炎与感染性休克显著相关，而患有软组织脓肿的患者往往表现为无感染性休克的轻度类鼻疽病。感染性休克、机械通气、重症监护病房入院、血清尿素、肌酐、碳酸氢盐、白蛋白和天门冬氨酸转氨酶在单变量分析中均与死亡率增加显著相关（均 P<0.05）。多变量分析显示，低血清碳酸氢盐（P=0.004，OR 0.64，95%CI 0.48-0.87）和白蛋白（P=0.031，OR 0.73，95%CI 0.54-0.97）可能与更高的死亡率相关。
类鼻疽病仍然是一种致命的感染，常见表现为菌血症和肺炎形式的感染性休克。血清碳酸氢盐和白蛋白这两个常规临床参数可能对败血症性类鼻疽病有重要的预后意义。
