{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:05:08Z","timestamp":1789499108226,"version":"build-2803163510"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014562","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000}}],"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["75N93022C00059"],"award-info":[{"award-number":["75N93022C00059"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["220211\/Z\/20\/Z"],"award-info":[{"award-number":["220211\/Z\/20\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Melioidosis is an infectious disease caused by the Gram-negative bacterium\n                      <jats:italic>Burkholderia pseudomallei<\/jats:italic>\n                      . The disease is difficult to diagnose and treat. Here, we investigated outcomes of patients with suspected or confirmed melioidosis in Laos and Thailand.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>\n                      We conducted a prospective, multinational, multicenter, observational study at Mahosot Hospital (MH) in Laos, and Srinagarind Hospital (SRH) and Sunpasitthiprasong Hospital (SUH) in Thailand. We enrolled adult patients (age\u2009\u2265\u200918 years) with suspected or confirmed melioidosis. For suspected-melioidosis cases, patients who had septic shock, had sepsis with at least one risk factor associated with melioidosis (including diabetes mellitus, chronic kidney disease, thalassemia major, malignancy and immunosuppressive therapy) or were prescribed ceftazidime or meropenem by attending physicians were enrolled, provided they were within 24 hours of hospitalization at the study hospitals. For confirmed-melioidosis cases, patients who had a clinical specimen tested positive for\n                      <jats:italic>B. pseudomallei<\/jats:italic>\n                      by either culture or antigen-detection immunofluorescence microscopy were enrolled. The primary endpoints were 28-day and 90-day mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Principal findings<\/jats:title>\n                    <jats:p>From November 2023 to October 2024, 627 patients were screened and 200 patients were enrolled (43 for suspected-melioidosis and 157 for confirmed-melioidosis). Five of 43 patients enrolled with suspected-melioidosis (12%) were subsequently diagnosed with culture-confirmed melioidosis since enrollment. 28-day and 90-day mortality were 14% (6\/43) and 23% (10\/43) in suspected-melioidosis patients, respectively; and 25% (39\/157) and 36% (57\/157) in confirmed-melioidosis patients, respectively. In multivariable Cox regression models, higher Sequential Organ Failure Assessment (SOFA) score at enrollment and intensive care unit (ICU) admission on the day of enrollment were strongly associated with mortality outcomes. Admission to SRH and longer duration of symptoms prior to enrollment were independently associated with survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Future clinical trials aiming to reduce mortality in patients with suspected or confirmed melioidosis should consider stratification based on the severity of organ dysfunction at enrollment. Differences in mortality between study sites may reflect residual confounding and should be carefully considered in sample size calculations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014562","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:54:16Z","timestamp":1788890056000},"page":"e0014562","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of patients with suspected or confirmed melioidosis: A prospective multinational, multicenter, observational study"],"prefix":"10.1371","volume":"20","author":[{"given":"Koukeo","family":"Phommasone","sequence":"first","affiliation":[{"name":"Mahosot Hospital","place":["Vientiane, Lao People's Democratic Republic"],"department":["Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory"]},{"name":"Mahosot Hospital","place":["Vientiane, Lao People's Democratic Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siriluck","family":"Anunnatsiri","sequence":"additional","affiliation":[{"name":"Khon Kaen University","place":["Khon Kaen, Thailand"],"department":["Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suwatthiya","family":"Kitsaran","sequence":"additional","affiliation":[{"name":"Sunpasitthiprasong Hospital","place":["Ubon Ratchathani, Thailand"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Mahidol University","place":["Bangkok, Thailand"],"department":["Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine"]},{"name":"University of Oxford","place":["Oxford, United Kingdom"],"department":["Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankham","family":"Vongphachanh","sequence":"additional","affiliation":[{"name":"Mahosot Hospital","place":["Vientiane, Lao People's Democratic Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ko","family":"Chang","sequence":"additional","affiliation":[{"name":"Mahosot Hospital","place":["Vientiane, Lao People's Democratic Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George H.","family":"Talbot","sequence":"additional","affiliation":[{"name":"AN2 Therapeutics","place":["Menlo Park, California, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"O\u2019Shea","sequence":"additional","affiliation":[{"name":"AN2 Therapeutics","place":["Menlo Park, California, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul B.","family":"Eckburg","sequence":"additional","affiliation":[{"name":"AN2 Therapeutics","place":["Menlo Park, California, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D.","family":"Prior","sequence":"additional","affiliation":[{"name":"AN2 Therapeutics","place":["Menlo Park, California, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Ashley","sequence":"additional","affiliation":[{"name":"Mahosot Hospital","place":["Vientiane, Lao People's Democratic Republic"],"department":["Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory"]},{"name":"University of Oxford","place":["Oxford, United Kingdom"],"department":["Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas P. 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