Improving the Long-Term Outcomes of Individuals with Melioidosis: Are Premature Deaths in Survivors Preventable?

Abstract

The case fatality rate of melioidosis in Australia is now less than 10%; however, many survivors of melioidosis die at an early age, soon after their hospital discharge. It is unclear whether more comprehensive, longitudinal healthcare could improve these patients' long-term outcomes. This study examined 290 consecutive individuals who survived their initial admission to an Australian referral hospital with culture-confirmed melioidosis between 2016 and 2024. They were followed for a median (interquartile range [IQR]) of 2.3 (0.9-4.2) years; 61/290 (21%) died at a median (IQR) of 0.8 (0.3-3.0) years after their diagnosis of melioidosis; the median (IQR) age at death was 65 (54-80) years. In multivariate analysis, active malignancy (hazard ratio [HR]; 95% CI): 4.09 (2.06-8.11), P <0.001), chronic kidney disease [HR (95% CI): 3.52 (1.91-6.48), P <0.001], immunosuppression [HR (95% CI): 2.01 (1.02-3.98), P = 0.04], or chronic lung disease [HR (95% CI): 1.93 (1.09-3.42), P = 0.02] at the time of the individual's initial presentation with melioidosis was associated with death after hospital discharge. Only one individual without significant underlying comorbidity died during follow-up. The cause of death could be determined in 43/61 (71%) and was frequently due to established, complex comorbidity; on review of the medical record, only 4 (9%) of these 43 deaths were felt to be preventable. Many Australians who survive melioidosis die soon after discharge at a relatively young age. Few of these deaths are easily preventable, but a diagnosis of melioidosis remains an opportunity to identify important comorbidities and optimize the patients' longitudinal care to reduce their subsequent morbidity and mortality.