1628. High Mortality and Relapse Rates of Melioidosis (Burkholderia pseudomallei infections) in Singapore
Session: Poster Abstract Session: Global Health
Saturday, October 10, 2015
Room: Poster Hall
  • ID week melioid poster V1.3 pdf.pdf (550.4 kB)
  • Background:

    Burkholderia pseudomallei is regarded as a bioterrorism threat and a common cause of community acquired infections in the tropics. Singapore is a small urban city without paddy fields and farming land spaces, but we continue to see cases of melioidosis. We report our 10-year clinical experience of patients with melioidosis managed in Singapore General Hospital and looked at the trends in the epidemiology, clinical features and mortality.


    Patients with a positive culture for B. pseudomallei during the period 1 Jan 2001 to 31 Dec 2010 were retrospectively identified and their case records were reviewed.


    Among 170 patients, 82.4% were male and were mostly blue-collar workers. Diabetes mellitus was reported in 51.8% and cigarette smoking in 53.4%. The duration of symptoms was less than 2 weeks in 57.0%, sub-acute in 23.0% and more than 1 month in 20.0%. Bacteremia was present in 70.0% and lung disease in 71.8%. All initial isolates were susceptible to ceftazidime and only 1 isolate was intermediate susceptible to imipenem.

    Among 156 patients started on induction therapy, 62.8% received only ceftazidime and 85.9% received more than 10 days of induction therapy. Among 126 patients who received maintenance therapy, 67.5% received the combination of co-trimoxazole and doxycycline and 61.1% received at least 20 weeks of therapy. Mortality rate was 25.9% with 16.5% attributable to melioidosis. Most (65.9%) deaths occurred early during the initial hospitalisation, with a median time to death of 6 days. Among the 142 survivors, there were 23.2% recurrences with the majority (69.7%) occurring in patients with incomplete treatment and a median time to recurrence of 53 days.


    In urbanised Singapore, our high mortality and recurrence rates are of concern. This highlights that melioidosis is still a serious infection locally and a need for aggressive therapeutics. We stress that prompt disease recognition with early appropriate treatment and compliance to therapy is critical. In-vitro antagonism between co-trimoxazole and doxycycline may have contributed to the high recurrence rates. A review of our traditional practice of using combination co-trimoxazole and doxycycline in the maintenance therapy and the recent shift in practice toward using co-trimoxazole only is underway.

    Mei Fong Jaime Chien, MRCP, Limin Wijaya, MRCP and Thuan Tong Tan, MRCP, Infectious Diseases, Singapore General Hospital, Singapore, Singapore


    M. F. J. Chien, None

    L. Wijaya, None

    T. T. Tan, None

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