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Clinical Characteristics and Outcome of Severe Melioidosis Requiring Intensive Care^*

^* From the Departments of Respiratory and Critical Care Medicine (Drs. Chan and Raghuram), Internal Medicine (Drs. Low and Kurup), and Clinical Research (Ms. Fook-Chong), Singapore General Hospital, Singapore.

Correspondence to: Kenneth P.W. Chan, MBBS, MMed, FCCP, Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Rd, Singapore 169608; e-mail: kpwchan{at}pacific.net.sg

Study objective: To describe the clinical characteristics and outcome of patients with severe melioidosis requiring intensive care.

Design: Retrospective chart review.

Setting: Two ICUs from a tertiary-care teaching hospital.

Patients: Twenty-seven adult ICU patients with microbiologically documented melioidosis.

Interventions: None.

Measurements and results: The median age was 59 years with a male preponderance (26:1). Twenty patients (74%) had medical comorbidities, with diabetes mellitus being the most common (59.3%). Almost all patients (96.3%) were bacteremic. Twenty patients (74.1%) presented with pneumonia. Twenty patients (74.1%) were in septic shock, and 16 patients (59.3%) had ARDS. Twelve patients (44.4%) required hemodialysis. The patients had a median of three organ dysfunctions, and the median APACHE (acute physiology and chronic health evaluation) II score was 27. The overall mortality was 48.1%. Mortality among patients with septic shock was 60%. The median ICU length of stay for survivors and nonsurvivors was 11 days and 2 days, respectively. Multivariate analysis revealed that the number of organ dysfunctions is an independent predictor of mortality (odds ratio, 8.2; 95% confidence interval, 1.3 to 51.4).

Conclusions: The outcome of severe melioidosis requiring intensive care is poor, with death being predicted by the number of organ dysfunctions.

Key Words: acute physiology and chronic health evaluation II • intensive care • melioidosis • mortality • organ dysfunction • sepsis

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