Session:

Bacterial Infections

Abstract No.:

45.003

Title:

Clinical characteristics and risk factors associated with melioidosis in Bintulu Hospital, Sarawak, Malaysia

Author(s):

F. Ahmad¹, A. A. Mohd Arshad², J. S. Wong¹, C. Goh³, A. Mohan⁴, A. Ayub⁵; ¹Hospital Bintulu, Department of Medicine, Bintulu, Sarawak/MY, ²Hospital Bintulu, Department of Anaesthesia and Intensive Care, Bintulu, Sarawak/MY, ³Hospital Bintulu, Department of Microbiology, Bintulu, Sarawak/MY, ⁴Hospital Bintulu, Department of Paediatrics, Bintulu, Sarawak/MY, ⁵Hospital Bintulu, Public Health, Bintulu, Sarawak/MY

Abstract:

Background: Melioidosis is an infection with gram negative bacterium Burkholderia pseudomallei and is an important public health problem causing community acquired sepsis in South East Asia and north Australia. The calculated annual incidence of melioidosis in Malaysia varies from around 6.0 per 100,000 per year to 16.35 per 100,000 population per year for adult population depending on region.
Methods: From October 2007 to January 2012, 416 patients were positive for melioidosis based on serology and 46 patients had microbiologically documented melioidosis. We undertook retrospective analysis of 46 cases with culture confirmed cases.
Results: The mean age of patient was 36 years old, with predominantly male (60.9%) and Iban ethnic group involvement ( 41.3%). Majority of patients were involved in farming, forestry and fishing ( 52.2%), followed by children and teenagers who were involved up to 17.4%. Majority did not have medical co morbidity (63.0%) unlike other reports where diabetes mellitus is one of the recognized risk factor.  Almost half of the patients ( 47.8%) were admitted to Intensive Care Unit (ICU) due to respiratory failure or septic shock. Pneumonia was the commonest presentation (69.9%) and accounted for 95.5% ICU admissions. Most patients received ceftazidime ( 52.2%), followed by meropenem ( 32.6%) and imipenem (2.2%). Only 13% did not received suggested antimicrobial treatment due to low suspicion. The overall mortality rate was  47.8%, but the rate was as high as 60.6% in pulmonary involvement. Based on in vitro sensitivity testing using disc diffusion method, 42.5% clinical isolates were resistant to meropenem. In vivo, we observed that 45.5% of patients whom received meropenem died.
Conclusion: Majority of our patients were younger, with more than half  having no medical co morbidity. Patients  mainly presented with lung involvement and bacteraemic. Pulmonary involvement carried a higher mortality rate despite appropriate treatment. In vitro resistance towards meropenem needs to be confirmed by minimum inhibitory method as it has colossal impact towards current clinical practice.