PREDICTING MORTALITY FOR MELIOIDOSIS 859 culture-confirmed melioidosis. Of these patients, 1,314 (59%) were male and 929 (41%) were female. Median age was 49 years (interquartile range [IQR] = 37–60 years), and 212 patients (9%) were less than 15 years of age. Death occurred in 956 patients (43%). On admission, blood, respiratory secretions, urine, throat swab, and pus/surface swab were obtained for culture from 1,997, 841, 1,152, 874, and 862 patients, respectively (Table 1). Of these patients, blood, respiratory secretions, urine, throat swab, and pus/surface swab culture were positive for B. pseudo- mallei in 1,160 (58%), 550 (65%), 255 (22%), 324 (37%) and 761 (85%) patients, respectively. Having a blood, respiratory secretion, urine, or throat swab culture obtained on admis- sion that was positive for B. pseudomallei was strongly asso- ciated with death (P ≤ 0.01, for all specimens) (Table 1). Having a pus/surface swab culture obtained on admission that was positive for B. pseudomallei was associated with a survival outcome, and most of these patients (58%, 443 of 761 patients) had only one localized lesion. Associations between death and a B. pseudomallei-positive respiratory secretion, urine, or throat swab culture on admission was independent of bacteremia (Table 2). Table 1 Prognostic value of a positive culture of blood, respiratory secretion, urine, throat swab, and pus/surface swab culture on admission, first follow-up sampling period (4–10 days after admission), and second follow-up sampling period (after day 10) in patients with melioidosis, Thailand* No. patients who died/total no. patients, (% mortality rate) Crude OR (95% CI) Adjusted OR† (95% CI) P‡ Pus/surface swab At hospitalization Positive 130/761 (17.1) 0.5 (0.3–0.8) 0.5 (0.3–0.9) 0.01 Negative 37/131 (28.2) During first follow-up sampling period Positive 18/114 (15.8) 2.1 (0.7–6.5) 1.5 (0.4–5.5) > 0.1 Negative 4/48 (8.3) During second follow-up sampling period Positive 12/92 (13.0) 4.8 (0.6–38.5) 6.7 (0.7–60) 0.09 Negative 1/33 (3.0) * OR = odds ratio; CI = confidence interval; Positive = positive for Burkholderia pseudomallei; Negative = negative for B. pseudomallei. †OR was adjusted for blood culture positive for B. pseudomallei, sex, age, history of diabetes, pneumonia, hypotension, and duration of in-hospital intravenous antimicrobial treatment received. ‡ P value for adjusted OR. Sample type and timing Blood At hospitalization Positive Negative During first follow-up sampling period Positive Negative During second follow-up sampling period Positive Negative Respiratory secretion At hospitalization Positive Negative During first follow-up sampling period Positive Negative During second follow-up sampling period Positive Negative Urine At hospitalization Positive Negative During first follow-up sampling period Positive Negative During second follow-up sampling period Positive Negative Throat swab At hospitalization Positive Negative During first follow-up sampling period Positive Negative During second follow-up sampling period Positive Negative 733/1,160 (63.2) 164/837 (19.6) 25/66 (37.9) 37/255 (14.5) 18/37 (48.7) 36/153 (23.5) 284/550 (51.6) 107/291 (36.8) 11/69 (15.9) 9/36 (25.0) 9/35 (25.7) 6/35 (17.1) 147/255 (57.7) 284/897 (31.7) 4/16 (25.0) 26/107 (24.3) 1/6 (16.7) 12/47 (25.5) 127/324 (39.2) 81/550 (14.7) 3/23 (13.0) 5/40 (12.5) 3/11 (27.3) 2/40 (5.0) 7.0 (5.7–8.7) 3.6 (2.0–6.6) 3.1 (1.5–6.5) 1.8 (1.4–2.5) 0.6 (0.2–1.5) 1.7 (0.5–5.3) 2.9 (2.2–3.9) 1.0 (0.3–3.5) 0.6 (0.1–5.5) 3.7 (2.7–5.2) 1.1 (0.2–4.9) 7.1 (1.0–49.8) 5.1 (4.0–6.6) 4.2 (2.1–8.7) 2.6 (1.1–6.0) 1.8 (1.1–2.8) 0.4 (0.1–1.5) 4.9 (0.8–31) 2.1 (1.5–3.0) 1.9 (0.4–8.3) 0.3 (0.0–5.8) 3.1 (2.0–4.8) 1.1 (0.2–7.1) 21 (0.5–871) < 0.001 < 0.001 0.03 0.01 > 0.1 0.09 < 0.001 > 0.1 > 0.1 < 0.001 > 0.1 > 0.1