{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:08:58Z","timestamp":1779361738455,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to multiple antibiotics, posing substantial challenges for treatment. Reports of acquired resistance are increasing, underscoring the need for global surveillance. Objective: This systematic review and meta-analysis aimed to determine the global prevalence of antibiotic-resistant B. pseudomallei isolated from human clinical cases, with a focus on regional differences and variations in antimicrobial susceptibility testing methods. Methods: We systematically searched PubMed, Scopus, and Embase for studies reporting resistance in clinical B. pseudomallei isolates, following PRISMA guidelines. Pooled resistance rates to 11 antibiotics were calculated using a random-effect model. Subgroup analyses were performed based on geographical region and testing methodology (MIC vs. disk diffusion). Results: Twelve studies comprising 10,391 isolates were included. Resistance rates varied across antibiotics, with the highest pooled resistance observed for tigecycline (46.3%) and ciprofloxacin (38.3%). Ceftazidime (CAZ) and trimethoprim\u2013sulfamethoxazole (SXT), commonly used first-line agents, showed resistance rates of 5.3% and 4.2%, respectively. Subgroup analyses of CAZ and SXT revealed significantly higher resistance in studies from Asia compared to Australia and America (p value &lt; 0.0001). Disk diffusion methods tended to overestimate resistance compared to MIC-based approaches, which revealed non-significant differences for CAZ (p value = 0.5343) but significant differences for SXT (p value &lt; 0.0001). Conclusions: Antibiotic resistance in B. pseudomallei exhibits regional variation and is influenced by the susceptibility testing method used. Surveillance programs and standardized antimicrobial susceptibility testing protocols are essential to guide effective treatment strategies and ensure accurate resistance reporting.<\/jats:p>","DOI":"10.3390\/antibiotics14070647","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T06:55:13Z","timestamp":1750920913000},"page":"647","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Global Prevalence of Antibiotic-Resistant Burkholderia pseudomallei in Melioidosis Patients: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4542-8980","authenticated-orcid":false,"given":"Jongkonnee","family":"Thanasai","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Mahasarakham University, Mahasarakham 44000, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sa-Ngob","family":"Laklaeng","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Supphachoke","family":"Khemla","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Nakhon Phanom Hospital, Nakhon Phanom 48000, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khonesavanh","family":"Ratanavong","sequence":"additional","affiliation":[{"name":"Savannakhet Health Science College, Savanakhet 13000, Laos"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3264-1155","authenticated-orcid":false,"given":"Moragot","family":"Chatatikun","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4768-7829","authenticated-orcid":false,"given":"Jitbanjong","family":"Tangpong","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5247-166X","authenticated-orcid":false,"given":"Wiyada Kwanhian","family":"Klangbud","sequence":"additional","affiliation":[{"name":"Medical Technology Program, Faculty of Science, Nakhon Phanom University, Nakhon Phanom 48000, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1586\/14787210.2014.970634","article-title":"Melioidosis: Molecular aspects of pathogenesis","volume":"12","author":"Stone","year":"2014","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1128\/CMR.00006-19","article-title":"Human Melioidosis","volume":"33","author":"Gassiep","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/S0140-6736(03)13374-0","article-title":"Melioidosis","volume":"361","author":"White","year":"2003","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"17107","DOI":"10.1038\/nrdp.2017.107","article-title":"Melioidosis","volume":"4","author":"Wiersinga","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.drup.2016.07.003","article-title":"Antibiotic resistance in Burkholderia species","volume":"28","author":"Rhodes","year":"2016","journal-title":"Drug Resist. Updates"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.2217\/fmb.12.116","article-title":"Mechanisms of antibiotic resistance in Burkholderia pseudomallei: Implications for treatment of melioidosis","volume":"7","author":"Schweizer","year":"2012","journal-title":"Future Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Ahmad, N., Hashim, R., and Mohd Noor, A. (2013). The In Vitro Antibiotic Susceptibility of Malaysian Isolates of Burkholderia pseudomallei. Int. J. Microbiol., 2013.","DOI":"10.1155\/2013\/121845"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1089\/mdr.2020.0362","article-title":"Antimicrobial Susceptibility of Western Hemisphere Isolates of Burkholderia pseudomallei: Phenotypic and Genomic Analyses","volume":"27","author":"Bugrysheva","year":"2021","journal-title":"Microb. Drug Resist."},{"key":"ref_9","first-page":"e02230-20","article-title":"Antibiotic susceptibility of clinical Burkholderia pseudomallei isolates in northeast Thailand during 2015\u20132018 and the genomic characterization of \u03b2-lactam-resistant isolates","volume":"95","author":"Fen","year":"2023","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.12669\/pjms.38.8.5506","article-title":"A clinical study on clinical features, manifestations and drug resistance of melioidosis","volume":"38","author":"Hui","year":"2022","journal-title":"Pak. J. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0924-8579(00)00334-4","article-title":"Antibiotic susceptibility of Burkholderia pseudomallei from tropical northern Australia and implications for therapy of melioidosis","volume":"17","author":"Jenney","year":"2001","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"132971","DOI":"10.1155\/2014\/132971","article-title":"Antimicrobial susceptibility and genetic characterisation of Burkholderia pseudomallei isolated from Malaysian patients","volume":"2014","author":"Khosravi","year":"2014","journal-title":"Sci. World J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jgar.2019.01.024","article-title":"Antimicrobial susceptibility of Burkholderia pseudomallei isolates in Northern Vietnam","volume":"18","author":"Nhung","year":"2019","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_14","first-page":"S12","article-title":"Prevalence of bla(PenA) and bla(OXA) in Burkholderia pseudomallei Isolated from Patients at Sappasitthiprasong Hospital and Their Susceptibility to Ceftazidime and Carbapenems","volume":"99","author":"Panya","year":"2016","journal-title":"J. Med. Assoc. Thail."},{"key":"ref_15","first-page":"S46","article-title":"Five-year surveillance for Burkholderia pseudomallei in Thailand from 2000 to 2004: Prevalence and antimicrobial susceptibility","volume":"92","author":"Paveenkittiporn","year":"2009","journal-title":"J. Med. Assoc. Thai."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"ofab460","DOI":"10.1093\/ofid\/ofab460","article-title":"Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia","volume":"8","author":"Sia","year":"2021","journal-title":"Open Forum Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jgar.2021.11.015","article-title":"In Vitro susceptibility of Burkholderia pseudomallei isolates from Thai patients to ceftolozane\/tazobactam and ceftazidime\/avibactam","volume":"28","author":"Sribenjalux","year":"2022","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5388","DOI":"10.1128\/AAC.05517-11","article-title":"Survey of antimicrobial resistance in clinical Burkholderia pseudomallei isolates over two decades in Northeast Thailand","volume":"55","author":"Wuthiekanun","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_19","unstructured":"Ministry of Public Health, Division of Communicable Disease (2025, May 06). Guideline of Melioidosis. Nonthaburi: Ministry of Public Health, Division of Communicable Disease, Available online: http:\/\/odpc5ratchaburi.com\/manual\/uploads\/other\/file_3074rks5eytu12d86fwj9hg.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Pitman, M.C., Luck, T., Marshall, C.S., Anstey, N.M., Ward, L., and Currie, B.J. (2015). Intravenous therapy duration and outcomes in melioidosis: A new treatment paradigm. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003586"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1080\/08998280.2006.11928154","article-title":"Tigecycline (Tygacil): The first in the glycylcycline class of antibiotics","volume":"19","author":"Greer","year":"2006","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1093\/jac\/45.6.813","article-title":"Comparison of efficacy of ciprofloxacin and doxycycline against experimental melioidosis and glanders","volume":"45","author":"Russell","year":"2000","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/S0140-6736(89)90768-X","article-title":"Halving of mortality of severe melioidosis by ceftazidime","volume":"2","author":"White","year":"1989","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.ijantimicag.2014.06.003","article-title":"Trimethoprim\/sulfamethoxazole resistance in Burkholderia pseudomallei","volume":"44","author":"Dance","year":"2014","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1086\/520219","article-title":"Comparison of imipenem and ceftazidime as therapy for severe melioidosis","volume":"29","author":"Simpson","year":"1999","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","first-page":"167","article-title":"A Comparison of Disk Diffusion and Etest with Broth Microdilution Methods for Susceptibility Testing of Ceftazidime and Trimethoprim\/Sulfamethoxazole Against Clinical Isolates of Burkholderia pseudomallei in Northeast Thailand","volume":"39","author":"Chea","year":"2024","journal-title":"Srinagarind Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.jclinepi.2014.03.003","article-title":"In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias","volume":"67","author":"Hunter","year":"2014","journal-title":"J. Clin. Epidemiol."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/647\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:58:40Z","timestamp":1760032720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/14\/7\/647"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":29,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["antibiotics14070647"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics14070647","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]}}}