{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:34:04Z","timestamp":1791952444608,"version":"4.3.4"},"reference-count":100,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    The case fatality rate of melioidosis in Australia is now less than 10%; however, many survivors of melioidosis die at an early age, soon after their hospital discharge. It is unclear whether more comprehensive, longitudinal healthcare could improve these patients\u2019 long-term outcomes. This study examined 290 consecutive individuals who survived their initial admission to an Australian referral hospital with culture-confirmed melioidosis between 2016 and 2024. They were followed for a median (interquartile range [IQR]) of 2.3 (0.9\u20134.2) years; 61\/290 (21%) died at a median (IQR) of 0.8 (0.3\u20133.0) years after their diagnosis of melioidosis; the median (IQR) age at death was 65 (54\u201380) years. In multivariate analysis, active malignancy (hazard ratio [HR]; 95% CI): 4.09 (2.06\u20138.11),\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001), chronic kidney disease [HR (95% CI): 3.52 (1.91\u20136.48),\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001], immunosuppression [HR (95% CI): 2.01 (1.02\u20133.98),\n                    <jats:italic>P<\/jats:italic>\n                    = 0.04], or chronic lung disease [HR (95% CI): 1.93 (1.09\u20133.42),\n                    <jats:italic>P<\/jats:italic>\n                    = 0.02] at the time of the individual\u2019s initial presentation with melioidosis was associated with death after hospital discharge. Only one individual without significant underlying comorbidity died during follow-up. The cause of death could be determined in 43\/61 (71%) and was frequently due to established, complex comorbidity; on review of the medical record, only 4 (9%) of these 43 deaths were felt to be preventable. Many Australians who survive melioidosis die soon after discharge at a relatively young age. Few of these deaths are easily preventable, but a diagnosis of melioidosis remains an opportunity to identify important comorbidities and optimize the patients\u2019 longitudinal care to reduce their subsequent morbidity and mortality.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0347","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T16:51:06Z","timestamp":1767113466000},"page":"424-431","source":"Crossref","is-referenced-by-count":1,"title":["Improving the Long-Term Outcomes of Individuals with Melioidosis: Are Premature Deaths in Survivors Preventable?"],"prefix":"10.4269","volume":"114","author":[{"given":"Megan","family":"Sandeman","sequence":"first","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Prideaux","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh","family":"Hanson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia;"},{"name":"The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Nat Rev Microbiol","first-page":"155","article-title":"Burkholderia pseudomallei and melioidosis","volume":"22","author":"Meumann","year":"2024"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"1737","article-title":"The Darwin Prospective Melioidosis Study: A 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021"},{"key":"b3","series-title":"Trop Med Infect Dis","first-page":"481","article-title":"The epidemiological, clinical, and microbiological features of patients with Burkholderia pseudomallei bacteraemia-implications for clinical management","volume":"8","author":"Prinsloo","year":"2023"},{"key":"b4","series-title":"Am J Trop Med Hyg","first-page":"328","article-title":"High rates of premature and potentially preventable death among patients surviving melioidosis in tropical Australia","volume":"101","author":"Hanson","year":"2019"},{"key":"b5","article-title":"Social Determinants of Health.","year":"2024"},{"key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e0009544","article-title":"Melioidosis \u2013 A disease of socioeconomic disadvantage","volume":"15","author":"Hanson","year":"2021"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0009704","article-title":"Comparative clinical characteristics and outcomes of patients with community acquired bacteremia caused by Escherichia coli, Burkholderia pseudomallei and Staphylococcus aureus: A prospective observational study (Ubon-sepsis)","volume":"15","author":"Somayaji","year":"2021"},{"key":"b8","series-title":"Emerg Infect Dis","first-page":"3119","article-title":"Increased incidence of melioidosis in Far North Queensland, Queensland, Australia, 1998\u20132019","volume":"27","author":"Smith","year":"2021"},{"key":"b9","series-title":"PLoS Negl Trop Dis","first-page":"e0005411","article-title":"The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management","volume":"11","author":"Stewart","year":"2017"},{"key":"b10","article-title":"Socio-Economic Indexes for Areas (SEIFA).","year":"2021"},{"key":"b11","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987"},{"key":"b12","series-title":"PLoS Negl Trop Dis","first-page":"e0010604","article-title":"Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia","volume":"16","author":"Davies","year":"2022"},{"key":"b13","article-title":"Deaths in Australia. Potentially Avoidable Deaths.","year":"2025"},{"key":"b14","article-title":"Aboriginal and Torres Strait Islander Life Expectancy.","year":"2023"},{"key":"b15","article-title":"Life Expectancy.","year":"2024"},{"key":"b16","series-title":"Acta Trop","first-page":"107480","article-title":"Mycotic aneurysms due to Burkholderia pseudomallei in Far North Queensland, tropical Australia: A case series and review of the literature","volume":"260","author":"Boyle","year":"2024"},{"key":"b17","series-title":"Acta Trop","first-page":"107559","article-title":"Melioidosis in people living with diabetes; clinical presentation, clinical course and implications for patient management","volume":"263","author":"Prideaux","year":"2025"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"257","article-title":"The applicability of commonly used severity of illness scores to tropical infections in Australia","volume":"106","author":"Salaveria","year":"2021"},{"key":"b19","series-title":"Crit Care Med","first-page":"1500","article-title":"Melioidosis causing critical illness: A Review of 24 years of experience from the Royal Darwin Hospital ICU","volume":"44","author":"Stephens","year":"2016"},{"key":"b20","article-title":"ANZDATA Registry. 44th Report, Mortality in Kidney Failure with Replacement Therapy.","year":"2021"},{"key":"b21","series-title":"PLoS Negl Trop Dis","first-page":"e0012631","article-title":"The characteristics and clinical course of patients with melioidosis and cancer","volume":"18","author":"Shukla","year":"2024"},{"key":"b22","article-title":"Rural and Remote Health.","year":"2024"},{"key":"b23","article-title":"Closing the Gap Annual Data Compilation Report.","year":"2024"},{"key":"b24","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1115","article-title":"The aetiology and incidence of infective endocarditis in people living with rheumatic heart disease in tropical Australia","volume":"42","author":"Basaglia","year":"2023"},{"key":"b25","series-title":"PLoS One","first-page":"e0284151","article-title":"The high burden of comorbidities in Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in Far North Queensland, Australia, and the implications for patient management","volume":"18","author":"Riddell","year":"2023"},{"key":"b26","series-title":"Intern Med J","first-page":"1155","article-title":"Chronic hepatitis B care in regional Australia: Implications for clinical practice and public health policy","volume":"54","author":"Han","year":"2024"},{"key":"b27","series-title":"Med J Aust","first-page":"512","article-title":"Diabetes care in remote northern Australian Indigenous communities","volume":"180","author":"McDermott","year":"2004"},{"key":"b28","series-title":"Microbiol Aust","first-page":"120","article-title":"Melioidosis in northern Australia","volume":"43","author":"Hanson","year":"2022"},{"key":"b29","series-title":"Clin Infect Dis","first-page":"979","article-title":"Risk factors for recurrent melioidosis in northeast Thailand","volume":"43","author":"Limmathurotsakul","year":"2006"},{"key":"b30","series-title":"Int J Infect Dis","first-page":"107283","article-title":"Adverse reactions to trimethoprim\/sulfamethoxazole for melioidosis eradication therapy: An evaluation of frequency and risk factors","volume":"150","author":"Martin","year":"2025"},{"key":"b31","series-title":"BMC Health Serv Res","first-page":"845","article-title":"A systematic review of adherence in Indigenous Australians: An opportunity to improve chronic condition management","volume":"17","author":"de Dassel","year":"2017"},{"key":"b32","series-title":"BMJ","first-page":"1313","article-title":"How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects","volume":"306","author":"Yudkin","year":"1993"},{"key":"b33","series-title":"JAMA Intern Med","first-page":"773","article-title":"Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: A meta-analysis","volume":"174","author":"Cheng","year":"2014"},{"key":"b34","series-title":"Circulation","first-page":"1872","article-title":"Twenty years of cardiovascular complications and risk factors in patients with type 2 diabetes: A nationwide Swedish cohort study","volume":"147","author":"Sattar","year":"2023"},{"key":"b35","series-title":"N Engl J Med","first-page":"2117","article-title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes","volume":"373","author":"Zinman","year":"2015"},{"key":"b36","series-title":"Cochrane Database Syst Rev","first-page":"Cd013650","article-title":"Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: A network meta-analysis","volume":"10","author":"Kanie","year":"2021"},{"key":"b37","series-title":"Addiction","first-page":"1773","article-title":"The effectiveness of inpatient and outpatient treatment for alcohol abuse: The need to focus on mediators and moderators of setting effects","volume":"91","author":"Finney","year":"1996"},{"key":"b38","series-title":"J Addict Med","first-page":"630","article-title":"Pharmacotherapies for adults with alcohol use disorders: A systematic review and network meta-analysis","volume":"16","author":"Bahji","year":"2022"},{"key":"b39","series-title":"Lancet Respir Med","first-page":"e7","article-title":"GOLD COPD report: 2025 update","volume":"13","author":"Venkatesan","year":"2025"},{"key":"b40","series-title":"Cochrane Database Syst Rev","first-page":"Cd002733","article-title":"Influenza vaccine for chronic obstructive pulmonary disease (COPD)","volume":"6","author":"Kopsaftis","year":"2018"},{"key":"b41","series-title":"Cochrane Database Syst Rev","first-page":"Cd003793","article-title":"Pulmonary rehabilitation for chronic obstructive pulmonary disease","volume":"2015","author":"McCarthy","year":"2015"},{"key":"b42","series-title":"Am J Respir Crit Care Med","first-page":"675","article-title":"Smoking and lung function of lung health study participants after 11 years","volume":"166","author":"Anthonisen","year":"2002"},{"key":"b43","series-title":"Int J Cardiol","first-page":"101","article-title":"Pulmonary cachexia","volume":"85","author":"Schols","year":"2002"},{"key":"b44","article-title":"Chronic Kidney Disease (CKD) Management in Primary Care.","year":"2024"},{"key":"b45","series-title":"Liver Transpl","first-page":"647","article-title":"Management of long-term complications from immunosuppression","volume":"30","author":"Russo","year":"2024"},{"key":"b46","series-title":"Pathogens","first-page":"943","article-title":"The incidence, aetiology and clinical course of serious infections complicating biological and targeted synthetic disease-modifying antirheumatic drug therapy in patients with rheumatoid arthritis in tropical Australia","volume":"13","author":"Price","year":"2024"},{"key":"b47","series-title":"Am Soc Clin Oncol Educ Book","first-page":"e100038","article-title":"Why and how to integrate early palliative care into cutting-edge personalized cancer care","volume":"44","author":"Petrillo","year":"2024"},{"key":"b48","series-title":"PLoS Negl Trop Dis","first-page":"e0008990","article-title":"The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997\u20132017; impact of socioeconomic status on disease burden, severity and access to care","volume":"15","author":"Kang","year":"2021"},{"key":"b49","series-title":"Curr Opin Infect Dis","first-page":"517","article-title":"Melioidosis and Burkholderia pseudomallei: Progress in epidemiology, diagnosis, treatment and vaccination","volume":"35","author":"Currie","year":"2022"},{"key":"b50","series-title":"Lancet Reg Health Southeast Asia","first-page":"100118","article-title":"Characteristics and one-year outcomes of melioidosis patients in Northeastern Thailand: A prospective, multicenter cohort study","volume":"9","author":"Chantratita","year":"2023"},{"key":"b1","series-title":"Nat Rev Microbiol","first-page":"155","article-title":"Burkholderia pseudomallei and melioidosis","volume":"22","author":"Meumann","year":"2024"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"1737","article-title":"The Darwin Prospective Melioidosis Study: A 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021"},{"key":"b3","series-title":"Trop Med Infect Dis","first-page":"481","article-title":"The epidemiological, clinical, and microbiological features of patients with Burkholderia pseudomallei bacteraemia-implications for clinical management","volume":"8","author":"Prinsloo","year":"2023"},{"key":"b4","series-title":"Am J Trop Med Hyg","first-page":"328","article-title":"High rates of premature and potentially preventable death among patients surviving melioidosis in tropical Australia","volume":"101","author":"Hanson","year":"2019"},{"key":"b5","article-title":"Social Determinants of Health.","year":"2024"},{"key":"b6","series-title":"PLoS Negl Trop Dis","first-page":"e0009544","article-title":"Melioidosis \u2013 A disease of socioeconomic disadvantage","volume":"15","author":"Hanson","year":"2021"},{"key":"b7","series-title":"PLoS Negl Trop Dis","first-page":"e0009704","article-title":"Comparative clinical characteristics and outcomes of patients with community acquired bacteremia caused by Escherichia coli, Burkholderia pseudomallei and Staphylococcus aureus: A prospective observational study (Ubon-sepsis)","volume":"15","author":"Somayaji","year":"2021"},{"key":"b8","series-title":"Emerg Infect Dis","first-page":"3119","article-title":"Increased incidence of melioidosis in Far North Queensland, Queensland, Australia, 1998\u20132019","volume":"27","author":"Smith","year":"2021"},{"key":"b9","series-title":"PLoS Negl Trop Dis","first-page":"e0005411","article-title":"The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management","volume":"11","author":"Stewart","year":"2017"},{"key":"b10","article-title":"Socio-Economic Indexes for Areas (SEIFA).","year":"2021"},{"key":"b11","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation","volume":"40","author":"Charlson","year":"1987"},{"key":"b12","series-title":"PLoS Negl Trop Dis","first-page":"e0010604","article-title":"Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia","volume":"16","author":"Davies","year":"2022"},{"key":"b13","article-title":"Deaths in Australia. Potentially Avoidable Deaths.","year":"2025"},{"key":"b14","article-title":"Aboriginal and Torres Strait Islander Life Expectancy.","year":"2023"},{"key":"b15","article-title":"Life Expectancy.","year":"2024"},{"key":"b16","series-title":"Acta Trop","first-page":"107480","article-title":"Mycotic aneurysms due to Burkholderia pseudomallei in Far North Queensland, tropical Australia: A case series and review of the literature","volume":"260","author":"Boyle","year":"2024"},{"key":"b17","series-title":"Acta Trop","first-page":"107559","article-title":"Melioidosis in people living with diabetes; clinical presentation, clinical course and implications for patient management","volume":"263","author":"Prideaux","year":"2025"},{"key":"b18","series-title":"Am J Trop Med Hyg","first-page":"257","article-title":"The applicability of commonly used severity of illness scores to tropical infections in Australia","volume":"106","author":"Salaveria","year":"2021"},{"key":"b19","series-title":"Crit Care Med","first-page":"1500","article-title":"Melioidosis causing critical illness: A Review of 24 years of experience from the Royal Darwin Hospital ICU","volume":"44","author":"Stephens","year":"2016"},{"key":"b20","article-title":"ANZDATA Registry. 44th Report, Mortality in Kidney Failure with Replacement Therapy.","year":"2021"},{"key":"b21","series-title":"PLoS Negl Trop Dis","first-page":"e0012631","article-title":"The characteristics and clinical course of patients with melioidosis and cancer","volume":"18","author":"Shukla","year":"2024"},{"key":"b22","article-title":"Rural and Remote Health.","year":"2024"},{"key":"b23","article-title":"Closing the Gap Annual Data Compilation Report.","year":"2024"},{"key":"b24","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"1115","article-title":"The aetiology and incidence of infective endocarditis in people living with rheumatic heart disease in tropical Australia","volume":"42","author":"Basaglia","year":"2023"},{"key":"b25","series-title":"PLoS One","first-page":"e0284151","article-title":"The high burden of comorbidities in Aboriginal and Torres Strait Islander Australians living with chronic hepatitis B in Far North Queensland, Australia, and the implications for patient management","volume":"18","author":"Riddell","year":"2023"},{"key":"b26","series-title":"Intern Med J","first-page":"1155","article-title":"Chronic hepatitis B care in regional Australia: Implications for clinical practice and public health policy","volume":"54","author":"Han","year":"2024"},{"key":"b27","series-title":"Med J Aust","first-page":"512","article-title":"Diabetes care in remote northern Australian Indigenous communities","volume":"180","author":"McDermott","year":"2004"},{"key":"b28","series-title":"Microbiol Aust","first-page":"120","article-title":"Melioidosis in northern Australia","volume":"43","author":"Hanson","year":"2022"},{"key":"b29","series-title":"Clin Infect Dis","first-page":"979","article-title":"Risk factors for recurrent melioidosis in northeast Thailand","volume":"43","author":"Limmathurotsakul","year":"2006"},{"key":"b30","series-title":"Int J Infect Dis","first-page":"107283","article-title":"Adverse reactions to trimethoprim\/sulfamethoxazole for melioidosis eradication therapy: An evaluation of frequency and risk factors","volume":"150","author":"Martin","year":"2025"},{"key":"b31","series-title":"BMC Health Serv Res","first-page":"845","article-title":"A systematic review of adherence in Indigenous Australians: An opportunity to improve chronic condition management","volume":"17","author":"de Dassel","year":"2017"},{"key":"b32","series-title":"BMJ","first-page":"1313","article-title":"How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects","volume":"306","author":"Yudkin","year":"1993"},{"key":"b33","series-title":"JAMA Intern Med","first-page":"773","article-title":"Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: A meta-analysis","volume":"174","author":"Cheng","year":"2014"},{"key":"b34","series-title":"Circulation","first-page":"1872","article-title":"Twenty years of cardiovascular complications and risk factors in patients with type 2 diabetes: A nationwide Swedish cohort study","volume":"147","author":"Sattar","year":"2023"},{"key":"b35","series-title":"N Engl J Med","first-page":"2117","article-title":"Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes","volume":"373","author":"Zinman","year":"2015"},{"key":"b36","series-title":"Cochrane Database Syst Rev","first-page":"Cd013650","article-title":"Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: A network meta-analysis","volume":"10","author":"Kanie","year":"2021"},{"key":"b37","series-title":"Addiction","first-page":"1773","article-title":"The effectiveness of inpatient and outpatient treatment for alcohol abuse: The need to focus on mediators and moderators of setting effects","volume":"91","author":"Finney","year":"1996"},{"key":"b38","series-title":"J Addict Med","first-page":"630","article-title":"Pharmacotherapies for adults with alcohol use disorders: A systematic review and network meta-analysis","volume":"16","author":"Bahji","year":"2022"},{"key":"b39","series-title":"Lancet Respir Med","first-page":"e7","article-title":"GOLD COPD report: 2025 update","volume":"13","author":"Venkatesan","year":"2025"},{"key":"b40","series-title":"Cochrane Database Syst Rev","first-page":"Cd002733","article-title":"Influenza vaccine for chronic obstructive pulmonary disease (COPD)","volume":"6","author":"Kopsaftis","year":"2018"},{"key":"b41","series-title":"Cochrane Database Syst Rev","first-page":"Cd003793","article-title":"Pulmonary rehabilitation for chronic obstructive pulmonary disease","volume":"2015","author":"McCarthy","year":"2015"},{"key":"b42","series-title":"Am J Respir Crit Care Med","first-page":"675","article-title":"Smoking and lung function of lung health study participants after 11 years","volume":"166","author":"Anthonisen","year":"2002"},{"key":"b43","series-title":"Int J Cardiol","first-page":"101","article-title":"Pulmonary cachexia","volume":"85","author":"Schols","year":"2002"},{"key":"b44","article-title":"Chronic Kidney Disease (CKD) Management in Primary Care.","year":"2024"},{"key":"b45","series-title":"Liver Transpl","first-page":"647","article-title":"Management of long-term complications from immunosuppression","volume":"30","author":"Russo","year":"2024"},{"key":"b46","series-title":"Pathogens","first-page":"943","article-title":"The incidence, aetiology and clinical course of serious infections complicating biological and targeted synthetic disease-modifying antirheumatic drug therapy in patients with rheumatoid arthritis in tropical Australia","volume":"13","author":"Price","year":"2024"},{"key":"b47","series-title":"Am Soc Clin Oncol Educ Book","first-page":"e100038","article-title":"Why and how to integrate early palliative care into cutting-edge personalized cancer care","volume":"44","author":"Petrillo","year":"2024"},{"key":"b48","series-title":"PLoS Negl Trop Dis","first-page":"e0008990","article-title":"The temporospatial epidemiology of rheumatic heart disease in Far North Queensland, tropical Australia 1997\u20132017; 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