Acute melioid community-acquired pneumonia

Objectives: To better understand the characteristics of patients with acute melioid community-acquired pneumonia (CAP) on emergency department (ED) arrival, and the risk factors in patients with acute melioid CAP that differ from those in patients with severe CAP of causes other than melioidosis. Methods: This was a retrospective case-control study. Results: During the study period, a total of 15 patients suffered from acute melioid CAP. Comparison with 60 patients with severe CAP of causes other than melioidosis, revealed that visit to the ED in the rainy season, shock on arrival, diabetes, poor sugar control with glycemia ≥250. mg/dl, chest radiograph with cavity formation, and poor clinical outcome, were significantly predominant in patients with acute melioid CAP. Multivariate logistic regression analysis indicated that poor sugar control with glycemia ≥250. mg/dl (odds ratio (OR) 38.3, 95% confidence interval (CI) 3.6-406.2; p<0.01), visiting the ED during the rainy season (OR 13.7, 95% CI 2.3-80.9; p<0.01), and shock on ED arrival (OR 18.7, 95% CI 1.8-192.8; p=0.01) were independent risk factors for patients with CAP caused by Burkholderia pseudomallei. Conclusions: Physicians in melioidosis endemic areas should administer antimicrobials covering B. pseudomallei to patients with CAP who visit the ED during the rainy season, who have poor sugar control with glycemia ≥250. mg/dl, and who are in shock on ED arrival, to facilitate timely, appropriate antibiotic therapy and lower the mortality rate.