Mortality among hospitalized children with melioidosis in Thailand - a retrospective national database analysis (2015-2023)

Sep 29, 2026

Upload by Franzy

Pediatric melioidosis in Thailand remains under-characterized nationally, limiting effective triage and critical-care planning. This retrospective national database analysis quantified epidemiology, complications, and mortality correlates among hospitalized patients under 18 years from January 2015 to December 2023. Among 5,044 admissions, overall mortality was 1.7% (84 deaths), clustering in tertiary hospitals. Deaths were higher with septic shock, lower respiratory tract infection, and acute respiratory failure, with a pneumonia-to-shock-to-DIC high-risk trajectory. Interventions integrating pediatric sepsis bundles and early melioidosis-active therapy are proposed.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Summary

Background

Methods

Findings

Interpretation

Funding

Research in context

Evidence before this study

Added value of this study

Articles Mortality among hospitalized children with melioidosis in Thailand: a retrospective national database analysis (2015–2023) Phanthila Sitthikarnkha,a Sirapoom Niamsanit,a Leelawadee Techasatian,a Suchaorn Saengnipanthkul,a Kaewjai Thepsuthammarat,b Pope Kosararaksa,a Nattakarn Tantawarak,a Punnathorn Auaboonkanok,a Phenphitcha Pornprasitsakul,a and Rattapon Uppalaa,∗ aDepartment of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand bClinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand Summary Background Pediatric melioidosis remains under-characterized nationally in Thailand, hindering triage and criticalcare planning. We quantified epidemiology, complications, and mortality correlates among hospitalized children. Methods Retrospective analysis of Thailand’s National Health Security Office database from January 2015 to Dec 2023, including patients <18 years with principal melioidosis. Incidence and case-fatality rate were calculated. Mortality-related clinical characteristics were compared using descriptive statistics. Findings Among 5044 admissions, 58.3% were male and 80.5% from the Northeast; annual incidence ranged 3.7–5.8 per 100,000, peaking in 2023. Median length of hospital stay was 11 days. Lower respiratory tract infection was the commonest localized focus (17.6%), followed by septic shock (2.9%) . Organ dysfunction consisted of acute respiratory failure 3.2%, acute renal failure 2.3%, and disseminated intravascular coagulation (DIC) 1.7% . There were 2.3% required intubation with mechanical ventilation >96 h, and 2.2% needed renal replacement therapy. Overall, 84 children died (1.7%); deaths clustered in tertiary hospitals (71.4%) . Mortality was markedly higher among children with septic shock, lower respiratory tract infection, and acute respiratory failure compared with children without these complications. Interpretation National data identify a Northeast-weighted pediatric burden and a high-risk trajectory from pneumonia to acute respiratory failure, shock, and DIC. Embedding pediatric sepsis bundles with early melioidosis-active therapy and seasonal pediatric intensive care unit (PICU) surge/transfer protocols, may shorten time-to-treatment and reduce deaths substantially and equitably. Funding This study was supported by the Fundamental Fund, Khon Kaen University, Thailand. Copyright © 2025 The Author(s) . Published by Elsevier Ltd. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). Keywords: Melioidosis; Hospitalization; Mortality; Children; Pneumonia Introduction Melioidosis is an infectious disease caused by B. pseudomallei, which can result in significant morbidity and mortality, particularly in pediatric populations.1 Thailand is a long-standing hotspot where melioidosis is an important cause of death nationwide and shows marked regional heterogeneity, reflecting environmental suitability, exposure patterns, and laboratory capacity.2 Children affected by melioidosis may present with a range of clinical manifestations, including pneumonia and septicemia. The clinical manifestations of melioidosis are heterogeneous and can mimic other bacterial infections, which makes diagnosing melioidosis more challenging.3 An interdisciplinary approach involving physicians, microbiologists, and radiologists is essential for accurate diagnosis and timely initiation of appropriate therapy.4,5 The presentation of melioidosis with shock constitutes a life-threatening emergency requiring immediate and aggressive intervention, including proper antibiotics, adequate fluid resuscitation, and supportive care.6,7 Several factors have been identified as associated with mortality in pediatric patients hospitalized with melioidosis. Particularly, the presence of septic shock The Lancet Regional Health -Southeast Asia 202

FAQs

What data source and study period were used to assess mortality in pediatric melioidosis in Thailand?

The study used Thailand’s National Health Security Office database for retrospective analysis from January 2015 to December 2023, including patients under 18 years with principal melioidosis.

What was the overall mortality rate and where did deaths concentrate?

Overall mortality was 1.7% (84 children died). Deaths clustered in tertiary hospitals, accounting for 71.4% of fatalities.

Which clinical complications were most strongly associated with higher mortality?

Mortality was markedly higher among children with septic shock, lower respiratory tract infection, and acute respiratory failure compared with children without these complications.

Sep 29, 2026

Upload by Franzy