Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia

Tonnii L L Sia; Anand Mohan; Mong-How Ooi; Su-Lin Chien; Lee-See Tan; Charles Goh; Daniel C L Pang; Bart J Currie; Jin-Shyan Wong; Yuwana Podin

doi:10.1093/ofid/ofab460

Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia

Open Forum Infect Dis. 2021 Sep 3;8(10):ofab460. doi: 10.1093/ofid/ofab460. eCollection 2021 Oct.

Authors

Tonnii L L Sia¹, Anand Mohan^{2

3}, Mong-How Ooi^{3

4}, Su-Lin Chien⁵, Lee-See Tan⁵, Charles Goh⁵, Daniel C L Pang⁶, Bart J Currie⁷, Jin-Shyan Wong^{8

9}, Yuwana Podin³

Affiliations

¹ Infectious Disease Unit, Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
² Department of Paediatrics, Bintulu Hospital, Bintulu, Sarawak, Malaysia.
³ Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia.
⁴ Department of Paediatrics, Sarawak General Hospital, Kuching, Sarawak, Malaysia.
⁵ Department of Pathology, Bintulu Hospital, Bintulu, Sarawak, Malaysia.
⁶ Bintulu Medical Centre, Bintulu, Sarawak, Malaysia.
⁷ Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
⁸ Borneo Medical Centre, Kuching, Sarawak, Malaysia.
⁹ Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Sarawak, Malaysia.

Abstract

Background: Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections.

Methods: We conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016.

Results: One hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B pseudomallei. The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections.

Conclusions: Gentamicin-susceptible B pseudomallei infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B pseudomallei infections in Sarawak are clonal and to ascertain their environmental drivers and niches.

Keywords: Burkholderia pseudomallei; Sarawak; clinical characteristics; gentamicin-susceptible; melioidosis.