Campbell, Stuart; Hicks, Dane; Shetty, Rajendra; Currie, Bart

Author(s)

Campbell, Stuart

Hicks, Dane

Shetty, Rajendra

Currie, Bart

Publication Date

2025-01-01

Abstract

Melioidosis is a multisystem infectious disease caused by the environmental bacterium . Osteomyelitis (OM) and septic arthritis (SA) are uncommon primary presentations for melioidosis but important secondary foci, often requiring prolonged therapy and multiple surgeries. We characterized the epidemiology, presentation, treatment, and outcomes of patients from 24 years of the Darwin Prospective Melioidosis Study (DPMS).DPMS patients from October 1, 1999, until September 30, 2023, were included if they had a primary or secondary diagnosis of OM or SA. Epidemiological, risk factor, clinical, and outcome data were retrieved from the DPMS database. Antibiotic and surgical data were collated from patient records.From 1129 consecutive patients with culture-confirmed melioidosis, 122 (10.8%) had OM and/or SA, with 115 evaluable. Ninety-four of 1129 (8.3%) had OM, and 62/1129 (5.5%) had SA, with 41/115 (35.7%) of these having both OM and SA. Many combined infections involved contiguous bone and joints or soft tissue. Fifty-nine (51.3%) were male, and only 4.3% were ≤16 years old. Diabetes mellitus was present in 69.6%, and only 12.2% had no identifiable clinical risk factor. There were 8 deaths (7.0%) and 20 (17.4%) recurrent infections. Seventy-one (61.7%) had operative management, with combined infection associated with more procedures and longer length of stay.The current paradigm of care for osteoarticular melioidosis involves prolonged intravenous antibiotics in conjunction with timely and complete operative management, and in our setting where these are available, outcomes are good. In many melioidosis-endemic regions these resources are limited, and mortality remains high.

Affiliation

Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Citation

Open Forum Infect Dis . 2024 Dec 19;12(1):ofae741. doi: 10.1093/ofid/ofae741. eCollection 2025 Jan.

ISSN

2328-8957

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/39758747/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/13904

Subject

Burkholderia pseudomallei

bone and joint infection

melioidosis

osteomyelitis

septic arthritis

Title

Osteomyelitis and Septic Arthritis in the Darwin Prospective Melioidosis Study.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Campbell, Stuart Hicks, Dane Shetty, Rajendra Currie, Bart
Publication Date	2025-01-01
Abstract	Melioidosis is a multisystem infectious disease caused by the environmental bacterium . Osteomyelitis (OM) and septic arthritis (SA) are uncommon primary presentations for melioidosis but important secondary foci, often requiring prolonged therapy and multiple surgeries. We characterized the epidemiology, presentation, treatment, and outcomes of patients from 24 years of the Darwin Prospective Melioidosis Study (DPMS).DPMS patients from October 1, 1999, until September 30, 2023, were included if they had a primary or secondary diagnosis of OM or SA. Epidemiological, risk factor, clinical, and outcome data were retrieved from the DPMS database. Antibiotic and surgical data were collated from patient records.From 1129 consecutive patients with culture-confirmed melioidosis, 122 (10.8%) had OM and/or SA, with 115 evaluable. Ninety-four of 1129 (8.3%) had OM, and 62/1129 (5.5%) had SA, with 41/115 (35.7%) of these having both OM and SA. Many combined infections involved contiguous bone and joints or soft tissue. Fifty-nine (51.3%) were male, and only 4.3% were ≤16 years old. Diabetes mellitus was present in 69.6%, and only 12.2% had no identifiable clinical risk factor. There were 8 deaths (7.0%) and 20 (17.4%) recurrent infections. Seventy-one (61.7%) had operative management, with combined infection associated with more procedures and longer length of stay.The current paradigm of care for osteoarticular melioidosis involves prolonged intravenous antibiotics in conjunction with timely and complete operative management, and in our setting where these are available, outcomes are good. In many melioidosis-endemic regions these resources are limited, and mortality remains high.
Affiliation	Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia. Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia. Department of Surgery, Royal Darwin Hospital, Darwin, Northern Territory, Australia. Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia. Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Citation	Open Forum Infect Dis . 2024 Dec 19;12(1):ofae741. doi: 10.1093/ofid/ofae741. eCollection 2025 Jan.
ISSN	2328-8957
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/39758747/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/13904
Subject	Burkholderia pseudomallei bone and joint infection melioidosis osteomyelitis septic arthritis
Title	Osteomyelitis and Septic Arthritis in the Darwin Prospective Melioidosis Study.
Type of document	Journal Article
Entity Type	Publication

Osteomyelitis and Septic Arthritis in the Darwin Prospective Melioidosis Study.

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