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

TL;DR

This study analyzed hospital data in Thailand to understand pediatric melioidosis mortality and identify risk factors for better treatment planning.

Contribution

The study provides national-level insights into pediatric melioidosis mortality and risk factors in Thailand, highlighting regional and clinical patterns.

Findings

Melioidosis incidence in children peaked in 2023, with the Northeast region most affected.

Children with septic shock, lower respiratory tract infection, and acute respiratory failure had higher mortality.

Most deaths occurred in tertiary hospitals, suggesting a need for improved pediatric intensive care protocols.

Abstract

Pediatric melioidosis remains under-characterized nationally in Thailand, hindering triage and critical-care planning. We quantified epidemiology, complications, and mortality correlates among hospitalized children.

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.

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.

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.

This study was supported by the Fundamental Fund, 10.13039/501100004071Khon Kaen University, Thailand.

Figures