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Journal of Clinical Microbiology, May 2005, p. 2274-2276, Vol. 43, No. 5
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.5.2274-2276.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Role and Significance of Quantitative Urine Cultures in Diagnosis of Melioidosis

Direk Limmathurotsakul,¹ Vanaporn Wuthiekanun,¹ Wirongrong Chierakul,¹ Allen C. Cheng,^1,2 Bina Maharjan,¹ Wipada Chaowagul,³ Nicholas J. White,^1,4 Nicholas P. J. Day,^1,4 and Sharon J. Peacock^1,4*

Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand,¹ Menzies School of Health Research, Charles Darwin University and Northern Territory Clinical School, Flinders University, Darwin, Australia,² Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand,³ Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, United Kingdom⁴

Received 22 November 2004/ Returned for modification 23 December 2004/ Accepted 19 January 2005

Melioidosis is associated with significant mortality in countries in which it is endemic. Previous studies have demonstrated that quantitative Burkholderia pseudomallei counts in blood are predictive of mortality. Here we examine the relationship between outcomes and quantitative B. pseudomallei counts in urine. A total of 755 patients presenting to Sappasithiprasong Hospital, Ubon Ratchathani, northeast Thailand (in the northeast part of the country), with melioidosis between July 1993 and October 2003 had quantitative urine cultures performed within 72 h of admission. Urine culture results were divided into the following groups: (i) no growth of B. pseudomallei from a neat sample or pellet, (ii) positive result from a centrifuged pellet only (<10³ CFU/ml), (iii) detection of between 10³ CFU/ml and 10⁵ CFU/ml from a neat sample, or (iv) detection of 10⁵ CFU/ml from a neat sample. The overall in-hospital mortality rate was 45%. Patients with negative urine cultures had the lowest death rate (39%). Mortality rates rose with increasing B. pseudomallei counts in urine, from 58% for those with positive spun pellets only to 61% for those with between 10³ CFU/ml and 10⁵ CFU/ml and 71% for those with 10⁵ CFU/ml. This was independent of age, presence of bacteremia, known risk factors for melioidosis such as diabetes, and the prior administration of antibiotics. The presence of B. pseudomallei in urine during systemic infection is associated with a poor prognosis.

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* Corresponding author. Mailing address: Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand. Phone: 66 2 354 9172. Fax: 66 2 354 9169. E-mail: sharon{at}tropmedres.ac.

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Journal of Clinical Microbiology, May 2005, p. 2274-2276, Vol. 43, No. 5
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.5.2274-2276.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

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