Baseline characteristics.

Background and objective
Pulmonary melioidosis, caused by Burkholderia pseudomallei, emerges as the most prevalent and highly fatal manifestation of melioidosis. Despite being a global health concern, pulmonary melioidosis remains insufficiently studied and reported.
Research question
Whether patients with pulmonary melioidosis have any potential characteristics or specific risk factors that are associated with their respiratory outcome’s trajectory.
Methods
A 5-year retrospective cohort study was conducted. Electronic medical records of patients admitted for Burkholderia pseudomallei pneumonia between January 1, 2019 and December 31, 2023, at Chaophraya Abhaibhubejhr hospital, Prachinburi, Thailand were reviewed.
Results
Of 1,486 adults admitted with bacterial pneumonia, 36 patients (2.4%) were diagnosed with microbiologically confirmed pulmonary melioidosis. Thirty of 36 patients (83.3%) developed acute respiratory failure requiring mechanical ventilation within 24 hours after admission. Twenty-three of 36 (63.9%) met the 2024 global definition of acute respiratory distress syndrome (ARDS) with 78% being moderate-to-severe ARDS. Pulmonary melioidosis with ARDS was associated with excessive alcohol consumption (p = 0.013) and body mass index (BMI) < 20 Kg/m2 (odds ratio of 6, 95%CI 1.080-33.321, p = 0.041) when compared to non-ARDS. BMI < 20 Kg/m2 was also associated with ARDS development, independent of age (odds ratio of 29.27 (95%CI 1.849 – 463.678, p = 0.017). The overall mortality rate of pulmonary melioidosis was 55.6%, with no differences between patients with ARDS and non-ARDS (65.2% vs 38.5%, respectively; p = 0.169).
Conclusion
ARDS frequently emerges in patients with pulmonary melioidosis requiring invasive mechanical ventilation and intensive care support. Excessive alcohol consumption and a low BMI status were associated with the development of ARDS in these patients.