Sia Tonnii L L, Mohan Anand, Ooi Mong-How, Chien Su-Lin, Tan Lee-See, Goh Charles, Pang Daniel C L, Currie Bart J, Wong Jin-Shyan, Podin Yuwana
Infectious Disease Unit, Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.
Open Forum Infect Dis. 2021 Sep 3;8(10):ofab460. doi: 10.1093/ofid/ofab460. eCollection 2021 Oct.
, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections.
We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016.
One hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible . The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections.
Gentamicin-susceptible infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant infections. Further studies are required to determine if all gentamicin-susceptible infections in Sarawak are clonal and to ascertain their environmental drivers and niches.
类鼻疽杆菌是类鼻疽病的病原体，对包括氨基糖苷类抗生素在内的多种抗生素具有内在抗性。在马来西亚砂拉越，相当一部分类鼻疽病病例是由对庆大霉素敏感的分离株引起的。关于这些感染的流行病学和临床数据有限。
我们对2011年1月至2016年12月期间在马来西亚砂拉越民都鲁医院住院的成年确诊类鼻疽病患者进行了一项回顾性研究。
共确定了148例成年确诊类鼻疽病患者。在接受检测的129例（87%）患者中，84例（65%）的类鼻疽杆菌对庆大霉素敏感。类鼻疽病的年平均发病率为每10万人12.3例，各地区之间存在显著差异，范围为每10万人5.8至29.3例。农村地区类鼻疽病的发病率较高，且对庆大霉素敏感的类鼻疽杆菌感染比例极高。对庆大霉素敏感的感染患者中，无明确危险因素的患者明显更多，该组中糖尿病患者较少见。98%的患者有急性症状。71%的患者报告有肺炎，这是最常见的症状。在接受影像学检查的患者中，54%发现有脾脓肿。88%的患者有菌血症；47%的患者发生感染性休克。45例（35%）患者死亡。对庆大霉素敏感和耐药的感染在临床、实验室或结局特征方面未发现差异。
对庆大霉素敏感的类鼻疽杆菌感染在砂拉越很常见，在发病率高的内陆农村地区占主导地位。其临床表现和结局与对庆大霉素耐药的类鼻疽杆菌感染相同。需要进一步研究以确定砂拉越所有对庆大霉素敏感的类鼻疽杆菌感染是否为克隆性感染，并确定其环境驱动因素和生态位。
