Majoni SW

Hughes JT

Heron, Bianca

Currie BJ

2018-01-01

Melioidosis causes sepsis and death in the Top End of Northern Australia during the monsoonal wet season. Dialysis-dependent adults suffer higher melioidosis rates compared to low rates among renal transplant patients who routinely receive trimethoprim+sulfamethoxazole prophylaxis. We performed a prospective interventional study to determine the efficacy and safety of daily trimethoprim+sulfamethoxazole prophylaxis in hemodialysis patients during the wet season, from 1 November 2014 to 30 April 2015. Hemodialysis (for ≥ 3 months) patients ≥ 18 years of age were offered treatment. A total of 269 patients on hemodialysis were eligible. Eight of the 269 patients (3%) were excluded from the analysis for being on melioidosis treatment. In all, 169 of 261 patients (64.8%) received the prophylaxis, and 92 of 261 patients (35.2%) did not, because of allergy history (n = 10), remoteness and logistical reasons (n = 60), poor dialysis attendance (n = 11), and refusal (n = 11). We monitored for clinical side effects 3 times weekly and neutropenia, thrombocytopenia, and liver function monthly throughout treatment and for 2 months posttreatment. In all, 169 of 261 patients (64.8%) received the prophylaxis. There was no age (years) difference by group (prophylaxis vs. nonprophylaxis, 54.7 [11.3] vs. 54.3 [11.2] [P = 0.751]). Sixteen of 261 patients (6%) had melioidosis. The event frequency was 0% (0/169, prophylaxis, vs. 17.4% [16/92, nonprophylaxis], P < 0.001). Higher thrombocytopenia and neutropenia rates were noted in the prophylaxis group. These did not warrant treatment stoppage. There was no difference in liver function. Three patients (1.8%) withdrew from the treatment because of side effects. Daily dosing was effective and safe. Posthemodialysis dosing in the subsequent seasons was effective and safer. We recommend this approach in melioidosis-prevalent regions.

Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Casuarina, Darwin, Northern Territory, Australia.. Northern Territory Medical Program, Flinders University School of Medicine, Tiwi, Darwin, Northern Territory, Australia.. Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia..

Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Casuarina, Darwin, Northern Territory, Australia.. Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia..

Department of Nephrology, Division of Medicine, Royal Darwin Hospital, Casuarina, Darwin, Northern Territory, Australia..

Northern Territory Medical Program, Flinders University School of Medicine, Tiwi, Darwin, Northern Territory, Australia.. Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.. Infectious Disease Department, Division of Medicine, Royal Darwin Hospital, Tiwi, Darwin, Northern Territory, Australia..

Kidney international reports 2018-01; 3(1): 160-167

https://pubmed.ncbi.nlm.nih.gov/29340327/?otool=iaurydwlib

https://hdl.handle.net/10137/5152

hemodialysis

melioidosis

northern Australia

sepsis

trimethoprim+sulfamethoxazole

wet season

Trimethoprim+Sulfamethoxazole Reduces Rates of Melioidosis in High-Risk Hemodialysis Patients.

Journal Article

Publication