Risk factors for recurrent melioidosis in northeast Thailand

Direk Limmathurotsakul*, Wipada Chaowagul, Wirongrong Chierakul, Kasia Stepniewska, Bina Maharjan, Vanaporn Wuthiekanun, Nicholas J. White, Nicholas P.J. Day, Sharon J. Peacock

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

111 Citations (Scopus)

Abstract

Background. Recurrent melioidosis occurs in ∼6% of patients in the first year following the initial presentation. A recent study revealed that 25% of patients with recurrence had reinfection rather than a relapse resulting from a failure to cure. The aim of this study was to reevaluate these 2 patient groups to define their individual risk factors. Methods. All adult patients who presented to Sappasithiprasong Hospital (Ubon Ratchathani, in northeast Thailand) with culture-confirmed melioidosis during the period 1986-2004 and who survived to receive oral antimicrobial therapy were observed until July 2005. Clinical factors and antimicrobial treatment of patients with recurrent disease due to relapse or reinfection, as confirmed by bacterial genotyping, were compared using a time-varying Cox proportional hazard model. Results. Of 889 patients who survived and underwent follow-up, 86 patients (9.7%) presented with relapse, and 30 patients (3.4%) became reinfected. There was no difference in acute outcome between the relapse and reinfection groups. No risk factors for reinfection were identified. Multivariate analyses identified choice and duration of oral antimicrobial therapy as the most important determinants of relapse, followed by positive blood culture result (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.18-2.92) and multifocal distribution (HR, 1.95; 95% CI, 1.03-3.67). Patients treated with an appropriate oral antibiotic regimen for 12-16 weeks had a 90% decreased risk of relapse (HR, 0.10; 95% CI, 0.02-0.44), compared with patients who were treated for ≤8 weeks. Trimethoprim-sulfamethoxazole plus doxycycline was an effective oral therapy. Conclusions. This study highlights clinical factors associated with an increased likelihood of relapse and provides vidence for optimal oral antimicrobial therapy.

Original languageEnglish
Pages (from-to)979-986
Number of pages8
JournalClinical Infectious Diseases
Volume43
Issue number8
DOIs
Publication statusPublished - 15 Oct 2006
Externally publishedYes

Bibliographical note

Funding Information:
Financial support. S.J.P. is supported by a Wellcome Trust Career Development Award in Clinical Tropical Medicine. This study was part of the Wellcome Trust–Mahidol University–Oxford Tropical Medicine Research Program and was funded by The Wellcome Trust. Potential conflicts of interest. All authors: no conflicts.

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