{
  "abstract": "Background: Melioidosis is an infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei. The disease is difficult to diagnose and treat. Here, we investigated outcomes of patients with suspected or confirmed melioidosis in Laos and Thailand. Methodology: We conducted a prospective, multinational, multicenter, observational study at Mahosot Hospital (MH) in Laos, and Srinagarind Hospital (SRH) and Sunpasitthiprasong Hospital (SUH) in Thailand. We enrolled adult patients (age ≥ 18 years) with suspected or confirmed melioidosis. For suspected-melioidosis cases, patients who had septic shock, had sepsis with at least one risk factor associated with melioidosis (including diabetes mellitus, chronic kidney disease, thalassemia major, malignancy and immunosuppressive therapy) or were prescribed ceftazidime or meropenem by attending physicians were enrolled, provided they were within 24 hours of hospitalization at the study hospitals. For confirmed-melioidosis cases, patients who had a clinical specimen tested positive for B. pseudomallei by either culture or antigen-detection immunofluorescence microscopy were enrolled. The primary endpoints were 28-day and 90-day mortality. Principal findings: From November 2023 to October 2024, 627 patients were screened and 200 patients were enrolled (43 for suspected-melioidosis and 157 for confirmed-melioidosis). Five of 43 patients enrolled with suspected-melioidosis (12%) were subsequently diagnosed with culture-confirmed melioidosis since enrollment. 28-day and 90-day mortality were 14% (6/43) and 23% (10/43) in suspected-melioidosis patients, respectively; and 25% (39/157) and 36% (57/157) in confirmed-melioidosis patients, respectively. In multivariable Cox regression models, higher Sequential Organ Failure Assessment (SOFA) score at enrollment and intensive care unit (ICU) admission on the day of enrollment were strongly associated with mortality outcomes. Admission to SRH and longer duration of symptoms prior to enrollment were independently associated with survival outcomes. Conclusions: Future clinical trials aiming to reduce mortality in patients with suspected or confirmed melioidosis should consider stratification based on the severity of organ dysfunction at enrollment. Differences in mortality between study sites may reflect residual confounding and should be carefully considered in sample size calculations. Author summary: Melioidosis is a frequently fatal infection caused by the soil bacterium Burkholderia pseudomallei and is a major cause of sepsis in Southeast Asia. Because the bacterium is intrinsically resistant to many commonly used antibiotics and melioidosis is difficult to diagnose using clinical presentation alone, clinicians often initiate empirical antibiotic therapy effective against B. pseudomallei once the disease is suspected. Treatment is continued for a complete course once the diagnosis is confirmed by bacterial culture results. However, patients treated for “suspected” melioidosis are seldom studied, and the factors associated with mortality in melioidosis remain poorly defined, in part because few studies have spanned more than one country. We prospectively followed 200 adults admitted with suspected or confirmed melioidosis at three hospitals in Laos and Thailand for 90 days. 90-day mortality was high in patients with both suspected and confirmed melioidosis. Factors associated with mortality included the severity of organ failure and intensive-care admission at enrollment, whereas a longer duration of symptoms before enrollment and care at one study hospital were associated with survival. These findings suggest that future trials aiming to reduce melioidosis mortality should account for organ-failure severity and between-hospital differences when designing patient selection and calculating sample size.",
  "abstract_shown": true,
  "affiliations": [
    "Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic",
    "Mahosot Hospital, Vientiane, Lao People's Democratic Republic",
    "Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand",
    "Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand",
    "Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand",
    "Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom",
    "AN2 Therapeutics, Menlo Park, California, United States of America",
    "Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Koukeo Phommasone"
    },
    {
      "affs": [
        1
      ],
      "name": "Siriluck Anunnatsiri"
    },
    {
      "affs": [
        2
      ],
      "name": "Suwatthiya Kitsaran"
    },
    {
      "affs": [
        3
      ],
      "name": "Sue J. Lee"
    },
    {
      "affs": [
        4
      ],
      "name": "Pankham Vongphachanh"
    },
    {
      "affs": [
        5
      ],
      "name": "Ko Chang"
    },
    {
      "affs": [
        6
      ],
      "name": "George H. Talbot"
    },
    {
      "affs": [
        7
      ],
      "name": "Kevin O’Shea"
    },
    {
      "name": "Paul B. Eckburg"
    },
    {
      "name": "Stephen D. Prior"
    },
    {
      "name": "Elizabeth A. Ashley"
    },
    {
      "name": "Nicholas P. J. Day"
    },
    {
      "name": "Direk Limmathurotsakul"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cv1962rcj8gwp.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pntd.0014562",
  "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014562",
  "id": "cv1962rcj8gwp",
  "issns": [
    "1935-2735"
  ],
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  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2713|Burkholderia infections and melioidosis"
    ],
    [
      "plos",
      "/Biology and life sciences/Anatomy/Body fluids/Blood"
    ],
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      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Bacterial pathogens/Burkholderia/Burkholderia pseudomallei"
    ],
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      "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials/Antibiotics"
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  "pmcid": null,
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  "published": "2026-09-08",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/cv1962rcj8gwp.ris",
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      "first_seen": "2026-10-30T12:17:56Z",
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  "subjects": [
    {
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  "title": "Outcomes of patients with suspected or confirmed melioidosis: A prospective multinational, multicenter, observational study",
  "title_text": "Outcomes of patients with suspected or confirmed melioidosis: A prospective multinational, multicenter, observational study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:56Z",
  "url": "https://research.draconitic.com/paper/cv1962rcj8gwp",
  "venue": "PLOS Neglected Tropical Diseases",
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