Clinical characteristics of patients with melioidosis treated in an emergency department

Background: Melioidosis has emerged as a global problem; however, few studies have specifically described the clinical characteristics and outcomes when patients with melioidosis are treated at an emergency department (ED). Purpose: The objective of this study was to examine the demographics and clinical characteristics of patients with melioidosis who visited an ED. Methods: A retrospective analysis of patients treated for melioidosis at an ED. Results: Of the 25 patients identified over 7 years, 22 patients had bacteremia, whereas diabetes mellitus was the most common underlying disease (17 patients). Acute respiratory failure requiring mechanical ventilation developed in 52% of the patients. The overall mortality rate was 40%, and death within 48 hours of presentation at the ED occurred in 24% of the patients. The most common infection site was the lungs (in 52% of patients), and 36% of the patients presented with community-acquired pneumonia (CAP) at the ED. A comparison of the CAP and non-CAP groups of patients revealed that the presence of shock upon arrival (56% vs. 0; . p=. 0.002), total mortality (78% vs. 19%; . p=. 0.009), and early mortality (56% vs. 6%; . p=. 0.012) were significantly more common among the individuals who comprised the CAP group. Early mortality accounted for 60% of total deaths, and all of these patients died before final microbiologic data were available. CAP presentation (. p=. 0.012), the presence of band-form leukocytes (. p=. 0.001), increased serum creatinine (. p=. 0.037), and shock on arrival (. p=. 0.005) were significantly more common among patients with early mortality. Conclusion: Melioidosis is a devastating illness with a high rate of mortality occurring within 48 hours of presentation. Melioidosis that presents with CAP is the most severe form of the disease and is associated with greatly increased early mortality. © 2012 .