0% 20% 40% 60% • Melioidosis is a severe tropical infection caused by Burkholderia pseudomallei , a Gram - negative bacterium • Melioidosis commonly presents as community - acquired pneumonia (CAP) and is associated with substantial 28 - day mortality • Limited data exists regarding long - term outcomes after melioidosis pneumonia • Determine 1 - year outcomes following hospital admission for melioidosis pneumonia, including • Death • Hospital readmission • Persistent symptoms ( e.g. shortness of breath, cough, chest pain, fatigue) • Determine risk factors for adverse 1 - year outcomes following hospital admission for melioidosis pneumonia • Prospective observational study that enrolled patients admitted with microbiologically confirmed melioidosis to nine hospitals in northeast Thailand between 2015 - 2018 • Follow up occurred every two months for one year after enrollment • Pneumonia was defined as an opacity, infiltrate, or consolidation on chest imaging obtained within 48 hours of admission • Modified Poisson regression performed to identify risk factors for all - cause mortality at one year • Competing risk analysis performed to identify risk factors for readmission in the first year after discharge, with death as a competing risk • Enrollment at culture positivity may exclude early deaths • Risk of pneumonia misclassification • Baseline symptoms prior to hospitalization are unknown • All - cause mortality in the year following hospitalization for melioidosis pneumonia is high • On e - year mortality is associated with critical illness but inversely associated with diabetes • Survivors to discharge with chronic kidney disease and/or hypertension have an increased risk of hospital readmission within one year • One in five patients experience persistent symptoms one year following hospitalization for melioidosis pneumonia • Investigate mechanisms that may explain the inverse association between diabetes and 1 - year mortality • Use clustering strategies to assess phenotypic heterogeneity • Determine whether treatment interventions are associated with improved long - term outcomes • T32HL007287, U01AI115520, & R01AI137111 Funding Source Methods Background Objectives Conclusions Limitations Results Future Directions Risk of Death or Readmission Months after admission 1 month *RR for 1 - year mortality s ignificant at α = 0.05 level after adjustment for age, sex , Charlson Comorbidity Index, and transfer status; RR for readmission adjusted for the same except transfer status not included No symptoms 6 months 12 months 1 - 2 symptoms ≥ 3 symptoms Death Chronic kidney disease No chronic kidney disease Survival Hospital Readmission Persistent Symptoms Months after discharge Proportion surviving Proportion readmitted Months after admission 100% 80% 60% 40% 20% 0% 60% 40% 20% 0% 2 Morbidity and Mortality Following Hospitalization for Melioidosis Pneumonia: Results from a Multicenter Cohort Study Coston TD 1 , Phunpang R 2,3 , Yarasai A 2 , Dulsuk A 2,3 , Yimthin T 2 , Thiansukhon E 4 , Chaisuksant S 5 , Tanwisaid K 6 , Chuananont S 6 , Morakot C 7 , Sangsa N 8 , Chayangsu S 9 , Silakun W 10 , Buasi N 11 , Chetchotisakd P 12 , Day N 3,13 , Lertmemongkolchai G 14,15 , Chantratita N 2,3 *, West TE 1,2 * 1 Division of Pulmonary, Critical Care & Sleep Medicine, University of Washington, Seattle, Washington; 2 Department of Microbiology and Immunology and 3 Mahidol - Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, 4 Udon Thani Hospital, 5 Khon Kaen Regional Hospital, 6 Nakhon Phanom Hospital, 7 Mukdahan Hospital, 8 Roi Et Hospital, 9 Surin Hospital, 10 Buriram Hospital, 11 Sisaket Hospital, 12 Srinagarind Hospital, Thailand; 13 Center of Tropical Medicine and Global Health, University of Oxford, Oxford, UK; 14 Department of Medical Technology, Faculty of Associated Medical Science, Chiang Mai University, Chiang Mai, Thailand; 15 The Centre for Research and Development of Medical Diagnostic Laboratories, Khon Kaen University, Khon Kaen , Thailand. *These authors contributed equally No diabetes Diabetes 4 6 8 1 0 1 2 2 4 6 8 1 0 1 2 Enrolled (n=542) RR 1-year mortality (n=238; 44%) Discharged alive (n=363) RR readmission (n=65; 20%) Baseline characteristics Age, median (IQR) 57 (47-65) 1.01 (0.99-1.02) 57 (47-64) 1.37 (0.93-2.02) Sex - male (%) 392 (72) 1.12 (0.90-1.39) 260 (72) 0.63 (0.38-1.03) BMI, median (IQR) 21 (29-24) 0.98 (0.96-1.12) 22 (19-24) 1.01 (0.94-1.09) Pre-existing conditions Charlson index, median (IQR) 2 (1-3) 1 (0.90-1.11) 2 (1-3) 1.02 (0.76-1.37) Diabetes (%) 379 (70) 0.76 (0.62-0.92)* 258 (71) 0.68 (0.39-1.17) Hypertension (%) 158 (29) 1.03 (0.84-1.27) 99 (27) 1.74 (1.02-2.96)* Chronic kidney disease (%) 62 (11) 1.15 (0.90-1.48) 37 (10) 3.54 (2.02-6.22)* Lung disease (%) 33 (6) 0.96 (0.67-1.37) 22 (6) 0.75 (0.28-2.04) Smoking (%) 191 (35) 1.02 (0.83-1.27) 126 (35) 0.6 (0.32-1.13) Alcohol use disorder (%) 14 (3) 0.99 (0.54-1.81) 8 (2) 1.75 (0.44-6.92) HIV (%) 6 (1) 1.61 (0.57-4.51) 3 (1) -- Previous melioidosis (%) 39 (7) 1.28 (0.95-1.72) 22 (6) 2.15 (0.93-4.97) Previous tuberculosis (%) 65 (12) 1.30 (1.04-1.64)* 34 (9) 0.74 (0.31-1.80) Clinical factors Bacteremia (%) 440 (81) 1.43 (1.07-1.89)* 282 (78) 1.26 (0.69-2.32) Transferred (%) 369 (68) 1.47 (1.16-1.86)* 231 (64) 1.12 (0.69-1.83) Appropriate antibiotics (%) 527 (97) 0.74 (0.51-1.08) 353 (97) 1.5 (0.22-10.1) Vasopressors (%) 243 (45) 2.95 (2.37-3.68)* 91 (25) 1.06 (0.60-1.88) Mechanical ventilation (%) 315 (58) 3.00 (2.26-3.98)* 144 (40) 1.2 (0.73-1.96) Treated in the ICU (%) 217 (40) 1.89 (1.56-2.28)* 96 (26) 1.29 (0.75-2.21) @ TaylorcostonMD costontd@uw.edu