A prospective observational study was conducted in 9 hospitals in Northeast Thailand from July 2015 to December 2018 (Chantratita et al., 2023 (link)). Written consents were obtained from the 1,361 adult male and female patients (age ≥ 15 years) with any specimens taken from any sites positive for B. pseudomallei by bacterial culture. Melioidosis patients who were pregnant, receiving palliative care, or incarceration were not enrolled in the study. B. pseudomallei were collected on the day of enrolment (day 0), and participants were followed up on days 5, 12, and 28 and every 2 months via phone call to collect data on the use of antibiotic therapy, clinical outcomes, and the occurrence of recurrent infections. Demographics and clinical data (age, sex, current illness, symptoms, vital signs, underlying morbidity, diagnosis, laboratory results, antimicrobial therapy, and clinical outcomes) of each participant were collected from medical records and hospital microbiology databases. Clinical and follow-up data were recorded in case report forms (CRFs).
Acute melioidosis was defined as the recent manifestation of melioidosis symptoms with a clinical sample culture growing B. pseudomallei, without any evidence of having (i) melioidosis before enrolment and (ii) recurrent infection during follow-up (Currie et al., 2000 (link)). Recurrent melioidosis was defined when a patient had (i) signs of infection determined by the attending physician and (ii) remained culture positive for B. pseudomallei at subsequent episodes after completion of antibiotic therapy. A patient with recurrent infection with the same B. pseudomallei genotype that was collected at the first episode was defined as relapse, whereas a patient who had recrudescence of a different genotype was defined as reinfection or was infected with multiple strains (Chantratita et al., 2023 (link)). A patient with no evidence of clinical response to oral antibiotic therapy and who subsequently remained culture positive for B. pseudomallei that shared the same genotype clone as the first isolate while undergoing antibiotic therapy was defined as having a persistent infection (Vargas et al., 2021 (link)).
Acute melioidosis was defined as the recent manifestation of melioidosis symptoms with a clinical sample culture growing B. pseudomallei, without any evidence of having (i) melioidosis before enrolment and (ii) recurrent infection during follow-up (Currie et al., 2000 (link)). Recurrent melioidosis was defined when a patient had (i) signs of infection determined by the attending physician and (ii) remained culture positive for B. pseudomallei at subsequent episodes after completion of antibiotic therapy. A patient with recurrent infection with the same B. pseudomallei genotype that was collected at the first episode was defined as relapse, whereas a patient who had recrudescence of a different genotype was defined as reinfection or was infected with multiple strains (Chantratita et al., 2023 (link)). A patient with no evidence of clinical response to oral antibiotic therapy and who subsequently remained culture positive for B. pseudomallei that shared the same genotype clone as the first isolate while undergoing antibiotic therapy was defined as having a persistent infection (Vargas et al., 2021 (link)).
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