Melioidosis: The hazards of incomplete peer-review

As researchers working on Burkholderia pseudomallei, we were interested to see the review by Perumal Samy and colleagues [1], which highlights the significant clinical impact and public health threat caused by melioidosis in the tropics.However, although the general content of the abstract is valid, unfortunately the review itself contains considerable misleading, incomplete, and inaccurate information.Whilst not wishing to appear unduly critical, we have become aware that the review is already causing clinicians and microbiologists confusion, which could have a dangerous impact on the care of melioidosis patients.This was reinforced during our second Cambodia National Melioidosis Workshop in October 2017, with several participants noting that they had read the open-access review and were following some of the (dangerously) incorrect information therein.We, therefore, felt obliged to write to highlight the issue, which we feel reflects a failure of the peer-review process and the authors' inadequate interpretation of recent advances in the melioidosis field.We have outlined some of the most important inaccuracies below.In many ways, the errors and inaccuracies in the section 'Antibiotic resistance and susceptibility/treatment of melioidosis' are the most worrying, because they may lead to inappropriate management of patients with melioidosis and possibly unnecessary deaths.We witnessed definite evidence of this risk during preparations for the meeting in Cambodia.This section has a number of inaccurate points.For example, on page 12, the statement "B.pseudomallei often develops resistance to existing antibiotics" is not true because, although acquired resistance has been reported, it is very rare with modern treatment regimens, and due to the absence of person-to-person spread, it represents a dead end when it does occur [2]."However, there is varying susceptibility to the various antibiotics, such as chloramphenicol, tetracyclines, trimethoprim-sulfamethoxazole, ureidopenicillins, cephalosporins, and clavulanic acid" is also untrue, because most isolates have a remarkably consistent susceptibility profile [2,3], and also, clavulanic acid is never used alone."Third-generation antibiotics, including cephalosporins, are not clinically useful in treating melioidosis" is misleading, because ceftazidime is generally considered the agent of