PREDICTING MORTALITY FOR MELIOIDOSIS 861 Lack of an association between death and persistently pos- itive respiratory secretions, urine, throat swab, and pus/sur- face swab is new evidence supporting previous observations.14 This finding adds to our experience that a small number of patients with persistent culture of these specimens can none- theless be cured with oral eradicative treatment.14 Localized lesions are difficult to eradicate and slow to resolve, but rou- tine follow-up culture of the related sample types does not appear to have any clinical utility. A limitation of this study is that not all clinical specimens were obtained from every patient. For example, there were only 779 patients with respiratory symptoms who had respi- ratory secretions and blood obtained for culture at admission (Table 2). In addition, follow-up cultures were not performed in every patient, and the timing of repeat cultures was variable. Nonetheless, these limitations do not affect the main conclu- sion of this study that blood culture should be followed up at least weekly in melioidosis patients and until a negative result is observed. Received October 31, 2010. Accepted for publication February 6, 2011. Acknowledgments: We thank Dr. Wirongrong Chierakul, the staff of Sappasithiprasong Hospital, and the Wellcome Trust-Oxford University-Mahidol University Tropical Medicine Research Program for assistance. Financial support: This study was supported by the Wellcome Trust. Authors’ addresses: Direk Limmathurotsakul, Department of Tropical Hygiene and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mail: direk@tropmedres.ac. Vanaporn Wuthiekanun, Gumphol Wongsuvan, Sukanya Pangmee, and Premjit Amornchai, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Trop- ical Medicine, Mahidol University, Bangkok, Thailand, E-mails: lek@ tropmedres.ac, gumphol@tropmedres.ac, sukanya@tropmedres.ac, and kung@tropmedres.ac. Prapit Teparrakkul, Department of Medi- cine, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand, E-mail: prapith_11@hotmail.com. Nittaya Teerawattanasook, Depart- ment Clinical Pathology, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand, E-mail: nidteerawa@hotmail.com. Nicholas P. J. Day, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand and Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, United Kingdom, E-mail: nickd@ tropmedres.ac. Sharon J. 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