Clinical Outcomes and Mortality Predictors of Melioidosis: A Four-Year Cohort Study from Malaysia

Melioidosis, caused by Burkholderia pseudomallei, is a frequently fatal tropical infection with diverse clinical manifestations. Malaysia, a Southeast Asian country with a population of 34.3 million, does not consider melioidosis to be a notifiable disease; therefore, the true incidence remains unknown. This retrospective cohort study describes the epidemiology, clinical features, clinical outcomes and predictors of mortality of melioidosis among culture-confirmed melioidosis cases admitted to Hospital Tuanku Ja’afar, Seremban (HTJS), the sole tertiary referral centre in the state of Negeri Sembilan, Malaysia, between 2021 and 2024. Overall, 107 patients were included. Most patients were middle-aged Malay males (83.2% male, 62.6% Malay), median age 51.9 years, with a high diabetes mellitus prevalence (78.5%). Frequent complications were bacteraemia (77.6%), septic shock (43.0%), pneumonia (38.3%) and multiorgan failure (30.7%). Mortality was 33.6% (n = 36), with 10 deaths occurring before treatment initiation. Septic shock was the only independent predictor of mortality (OR 10.945; 95% CI: 2.827–42.367; p = 0.001). Melioidosis in our study predominantly affects diabetic, middle-aged Malay men and carries high mortality, mirroring patterns observed in other Malaysian states. Septic shock strongly predicts death, highlighting the need for early identification and aggressive management to improve outcomes.