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Prinsloo C, Smith S, Law M, Hanson J. The Epidemiological, Clinical, and Microbiological Features of Patients with Burkholderia pseudomallei Bacteraemia-Implications for Clinical Management. Trop Med Infect Dis 2023; 8:481. [PMID: 37999600 PMCID: PMC10675116 DOI: 10.3390/tropicalmed8110481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Patients with melioidosis are commonly bacteraemic. However, the epidemiological characteristics, the microbiological findings, and the clinical associations of Burkholderia pseudomallei bacteraemia are incompletely defined. All cases of culture-confirmed melioidosis at Cairns Hospital in tropical Australia between January 1998 and June 2023 were reviewed. The presence of bacteraemia was determined and correlated with patient characteristics and outcomes; 332/477 (70%) individuals in the cohort were bacteraemic. In multivariable analysis, immunosuppression (odds ratio (OR) (95% confidence interval (CI)): (2.76 (1.21-6.27), p = 0.02), a wet season presentation (2.27 (1.44-3.59), p < 0.0001) and male sex (1.69 (1.08-2.63), p = 0.02), increased the likelihood of bacteraemia. Patients with a skin or soft tissue infection (0.32 (0.19-0.57), p < 0.0001) or without predisposing factors for melioidosis (0.53 (0.30-0.93), p = 0.03) were less likely to be bacteraemic. Bacteraemia was associated with intensive care unit admission (OR (95%CI): 4.27 (2.35-7.76), p < 0.0001), and death (2.12 (1.04-4.33), p = 0.04). The median (interquartile range) time to blood culture positivity was 31 (26-39) hours. Patients with positive blood cultures within 24 h were more likely to die than patients whose blood culture flagged positive after this time (OR (95%CI): 11.05 (3.96-30.83), p < 0.0001). Bacteraemia portends a worse outcome in patients with melioidosis. Its presence or absence might be used to help predict outcomes in cases of melioidosis and to inform optimal clinical management.
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Affiliation(s)
- Carmen Prinsloo
- College of Medicine and Dentistry, James Cook University, Cairns Hospital, Cairns, QLD 4870, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia;
| | - Matthew Law
- The Kirby Institute, University of New South Wales, Sydney, NSW 2042, Australia;
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia;
- The Kirby Institute, University of New South Wales, Sydney, NSW 2042, Australia;
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
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Adegbite BR, Edoa JR, Ndzebe Ndoumba WF, Dimessa Mbadinga LB, Mombo-Ngoma G, Jacob ST, Rylance J, Hänscheid T, Adegnika AA, Grobusch MP. A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle -Income Countries: a systematic review and meta-analysis. EClinicalMedicine 2021; 42:101184. [PMID: 34765956 PMCID: PMC8569629 DOI: 10.1016/j.eclinm.2021.101184] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical scores for sepsis have been primarily developed for, and applied in High-Income Countries. This systematic review and meta-analysis examined the performance of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and Universal Vital Assessment (UVA) scores for diagnosis and prediction of mortality in patients with suspected infection in Low-and-Middle-Income Countries. METHODS PubMed, Science Direct, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched until May 18, 2021. Studies reporting the performance of at least one of the above-mentioned scores for predicting mortality in patients of 15 years of age and older with suspected infection or sepsis were eligible. The Quality Assessment of Diagnostic Accuracy Studies tool was used for risk-of-bias assessment. PRISMA guidelines were followed (PROSPERO registration: CRD42020153906). The bivariate random-effects regression model was used to pool the individual sensitivities, specificities and areas-under-the-curve (AUC). FINDINGS Twenty-four articles (of 5669 identified) with 27,237 patients were eligible for inclusion. qSOFA pooled sensitivity was 0·70 (95% confidence interval [CI] 0·60-0·78), specificity 0·73 (95% CI 0·67-0·79), and AUC 0·77 (95% CI 0·72-0·82). SIRS pooled sensitivity, specificity and AUC were 0·88 (95% CI 0·79 -0·93), 0·34 (95% CI 0·25-0·44), and 0·69 (95% CI 0·50-0·83), respectively. MEWS pooled sensitivity, specificity and AUC were 0·70 (95% CI 0·57 -0·81), 0·61 (95% CI 0·42-0·77), and 0·72 (95% CI 0·64-0·77), respectively. UVA pooled sensitivity, specificity and AUC were 0·49 (95% CI 0·33 -0·65), 0·91(95% CI 0·84-0·96), and 0·76 (95% CI 0·44-0·93), respectively. Significant heterogeneity was observed in the pooled analysis. INTERPRETATION Individual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores. FUNDING Partially funded by the UK National Institute for Health Research (NIHR) (17/63/42).
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Affiliation(s)
- Bayode R Adegbite
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Jean R Edoa
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Wilfrid F Ndzebe Ndoumba
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
| | - Lia B Dimessa Mbadinga
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool
- Walimu, Kampala, Uganda
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool
- Malawi-Liverpool-Wellcome Trust, Chichiri, Blantyre, Malawi
| | - Thomas Hänscheid
- Instituto de Microbiologica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
- MasangaMedical Research Unit, Masanga, Sierra Leone
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Correspondence: Prof. Martin P. Grobusch, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands, Phone: +31 6 566 4380
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