KWT CHAU1, S SMITH1,2, K KANG1, S DHEDA1, J HANSON1,3
1Department of Medicine, Cairns Hospital, Cairns, Australia, 2James Cook University, Cairns, Australia, 3The Kirby Institute, Sydney, Australia
Aim: To evaluate if oral Trimethoprim/Sulfamethoxazole (TMP/SMX) as melioidosis prophylaxis is warranted in tropical northern Queensland
Background: Melioidosis, caused by the environmental, opportunistic bacteria Burkholderia pseudomallei, is endemic in the tropics. Melioidosis continues to cause significant morbidity and mortality, even with optimum medical care. In the absence of a suitable vaccine, strategies to prevent melioidosis are required. Chronic haemodialysis patients are particularly at risk and daily prophylactic TMP/SMX has been trialled to reduce the incidence of melioidosis in this population.
Methods: Cairns Hospital laboratory is the sole provider for public microbiology services in Far North Queensland (FNQ). The hospital manages haemodialysis in the region across multiple sites. We reviewed all cases of culture-confirmed Burkholderia Pseudomallei isolated from January 1997 to December 2017. We compared this data with dialysis database and ANZDATA during the same period to determine the incidence of melioidosis in the haemodialysis population in FNQ.
Results: Over the 21-year study period, there were 242 cases of melioidosis; 3 of which occurred amongst 843 chronic haemodialysis patients over 21 years (3037 cumulative patient-years). All 3 patients receiving chronic haemodialysis survived without requiring ICU support.
Conclusions: Universal adoption of TMP/SMX prophylaxis may not yet be justifiable in FNQ after taking into consideration the large number needed to treat. In our centre, assuming that TMP/SMX prophylaxis had a 100% efficacy, 843 patients would require treatment over 20years to prevent 3 cases. Adverse reactions associated with TMP/SMX have been reported as high as 8%. We recommend other melioidosis endemic regions evaluate their own data prior to adoption of prophylactic antibiotics in chronic haemodialysis patients.
Dr Chau is Medical Registrar working at Cairns Base Hospital, looking after patients who presented acutely to Medical Assessment Unit and other specialties. He graduated from Queens’ University of Belfast, previously working and trained at United Kingdom before continuing his medical training at Australia. During his training in the United Kingdom, he has conducted numerous local and national audits, resulting in local hospital implementation to improve patient care. He also has had previous experience in research, participating in data collection and data analysis. He is now working on a few infectious diseases/nephrology related regional projects.