# 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.

## Key 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.