Background: Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to multiple antibiotics, posing substantial challenges for treatment. Reports of acquired resistance are increasing, underscoring the need for global surveillance. Objective: This systematic review and meta-analysis aimed to determine the global prevalence of antibiotic-resistant B. pseudomallei isolated from human clinical cases, with a focus on regional differences and variations in antimicrobial susceptibility testing methods. Methods: We systematically searched PubMed, Scopus, and Embase for studies reporting resistance in clinical B. pseudomallei isolates, following PRISMA guidelines. Pooled resistance rates to 11 antibiotics were calculated using a random-effect model. Subgroup analyses were performed based on geographical region and testing methodology (MIC vs. disk diffusion). Results: Twelve studies comprising 10,391 isolates were included. Resistance rates varied across antibiotics, with the highest pooled resistance observed for tigecycline (46.3%) and ciprofloxacin (38.3%). Ceftazidime (CAZ) and trimethoprim–sulfamethoxazole (SXT), commonly used first-line agents, showed resistance rates of 5.3% and 4.2%, respectively. Subgroup analyses of CAZ and SXT revealed significantly higher resistance in studies from Asia compared to Australia and America (p value < 0.0001). Disk diffusion methods tended to overestimate resistance compared to MIC-based approaches, which revealed non-significant differences for CAZ (p value = 0.5343) but significant differences for SXT (p value < 0.0001). Conclusions: Antibiotic resistance in B. pseudomallei exhibits regional variation and is influenced by the susceptibility testing method used. Surveillance programs and standardized antimicrobial susceptibility testing protocols are essential to guide effective treatment strategies and ensure accurate resistance reporting.

Background: Travel-associated melioidosis, caused by Burkholderia pseudomallei, is increasingly reported in non-endemic countries due to rising global travel. Understanding demographic, clinical, and outcome patterns of imported cases is important to improve recognition and management in settings where melioidosis is uncommon. Methods: We systematically searched PubMed, Embase, and Scopus (last search: 24 September 2025) for case reports and case series of melioidosis diagnosed outside endemic regions and linked to travel exposure. Data were extracted on demographics, comorbidities, clinical manifestations, and outcomes. We performed descriptive analyses, subgroup analyses, and Firth’s penalized logistic regression to explore predictors of death. The protocol was registered in PROSPERO (CRD420251154559). Results: A total of 104 studies, encompassing 143 individual cases, were included. Most diagnoses occurred in non-endemic, high-income countries, especially the Netherlands (21%), France (10%), the United States (9%), and South Korea (7%). Infections were predominantly acquired in Southeast Asia, particularly Thailand (39%). The mean patient age was 50.6 years, with a male predominance (78%). Diabetes mellitus was the most frequent comorbidity (28%). Clinical presentations included pulmonary (33%), sepsis (27%), cutaneous (13%), abdominal (4%), and osteoarticular disease (1%). Overall mortality was 12.6% and relapse occurred in 7%. In penalized regression analyses, no baseline characteristic was statistically significantly associated with mortality; septic presentation showed an elevated point estimate for odds of death, but with imprecise estimates. Conclusions: Travel-associated melioidosis is a rare but clinically significant imported infection. Most cases followed exposure in Southeast Asia, and pulmonary disease and sepsis were the most frequent presentations. Mortality remained substantial (12.6%), and relapse was reported in 7%, underscoring the need for early recognition, appropriate therapy, and follow-up in non-endemic settings.

Background: Melioidosis, caused by Burkholderia pseudomallei, is a serious infectious disease in Southeast Asia and northern Australia. Methods: We systematically reviewed observational studies measuring C-reactive protein (CRP) in laboratory-confirmed melioidosis for diagnosis, severity assessment, or outcome evaluation. PubMed, Embase, and Scopus were searched up to May 2025. Data were pooled using a random-effects model; heterogeneity was quantified (I²). Results: Seven studies (n = 451) were included. The pooled mean CRP level in melioidosis was 74.37 mg/L (95% Confidence Interval [CI], 32.76–168.83; I² = 99.1%), considerably higher than healthy reference values (<10 mg/L). Conclusions: CRP is consistently raised in melioidosis and may aid in early diagnosis and severity monitoring, although high heterogeneity limits the precision of pooled estimates. Integration of CRP into multimodal prediction tools, rather than use in isolation, is recommended. Further prospective studies should define optimal diagnostic thresholds.

Background. Melioidosis is a severe infection caused by Burkholderia pseudomallei and is endemic in regions with a high prevalence of thalassemia. Patients with thalassemia are thought to be at increased risk due to iron overload, splenectomy, and immune dysfunction. However, the pooled prevalence and mortality outcomes of melioidosis in this population remain unclear. Methods. We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines (PROSPERO: CRD420251108294). PubMed, Embase, and Scopus were searched from inception to July 2025. Observational studies reporting prevalence or mortality of melioidosis in patients with thalassemia were eligible. Pooled odds ratios (ORs) for mortality were calculated using random-effects models, with subgroup and sensitivity analyses based on age, thalassemia subtype, and study quality. Results. Six retrospective studies including 7529 melioidosis patients, of whom 173 had thalassemia, were analyzed. The prevalence of thalassemia among melioidosis cases ranged from 0.5% to 40.7%. Mortality among thalassemia patients varied from 0% to 100%. Pooled analysis demonstrated no significant excess mortality compared with non-thalassemia controls (OR 0.55, 95% CI 0.16–1.89; I² = 44.9%). Sensitivity analysis restricted to moderate- and high-quality studies showed a significantly lower risk of death (OR 0.23, 95% CI 0.15–0.36; I² = 0%). Subgroup analyses by thalassemia subtype and age revealed no clear effect modification, although power was limited. Conclusions. Despite biological plausibility, thalassemia was not associated with increased melioidosis mortality. These findings suggest that closer clinical monitoring, iron chelation, and comorbidity profiles may influence outcomes. Prospective, well-characterized cohort studies are needed to refine risk stratification and guide management in endemic regions.

Background: Melioidosis is a severe infectious disease caused by Burkholderia pseudomallei, with high mortality rates, particularly in severe cases complicated by acute kidney injury (AKI). Objective: The objective of this study was to systematically review and quantitatively synthesize the impact of AKI on mortality and other clinical outcomes—including ICU admission and the need for renal replacement therapy (RRT)—in patients with melioidosis. Methods: A systematic search was conducted in PubMed, Scopus, and Embase up to 16 May 2025. Studies reporting mortality, ICU admission, or RRT use in patients with AKI were included. A random-effects meta-analysis was performed to estimate the odds ratio (OR) for mortality associated with AKI. Results: Twenty-nine studies (380 patients) were included. AKI occurred in 123 patients (32.4%). The pooled analysis revealed that AKI patients had a significantly higher mortality risk than non-AKI patients (OR = 23.37; 95% CI: 13.97–39.10; p = 0.0082), with no significant heterogeneity (I² = 0%). Sensitivity analysis confirmed the robustness of this association. ICU admission and RRT data were frequently reported but were not suitable for meta-analysis due to insufficient data. Conclusions: AKI is a serious complication in melioidosis, significantly increasing the risk of mortality. Early recognition and aggressive management of AKI in melioidosis may be critical to improving clinical outcomes.

Background: Melioidosis is a potentially fatal infectious disease caused by Burkholderia pseudomallei and is highly prevalent in tropical regions. Diabetes mellitus (DM) is the most common comorbidity among patients with melioidosis and is a well-established risk factor for acquiring the infection. However, the impact of diabetes on disease severity and mortality remains uncertain. Methods: We conducted a systematic review and meta-analysis of observational studies to evaluate the association between diabetes mellitus and severe clinical outcomes in patients with melioidosis. PubMed, Embase, and Scopus were searched from database inception to 6 January 2026. Outcomes of interest included bacteremia, septic shock, intensive care unit (ICU) admission, and mortality. Pooled odds ratios with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic. The review was registered in PROSPERO (CRD420251237028). Results: Twelve studies comprising patients from Southeast Asia, Australia, and South Asia were included. Diabetes prevalence among patients with melioidosis ranged from 31% to 76%. Meta-analysis showed no significant association between diabetes mellitus and bacteremia (OR 1.48, 95% CI 0.97–2.27), ICU admission (OR 1.31, 95% CI 0.43–3.99), septic shock (OR 0.67, 95% CI 0.39–1.16), or mortality (OR 0.82, 95% CI 0.66–1.03). Subgroup analysis revealed lower mortality among patients with diabetes in Southeast Asia (OR 0.74, 95% CI 0.61–0.91), while no significant association was observed in Australia. Heterogeneity varied across outcomes and regions. Conclusions: Although diabetes mellitus is a major risk factor for acquiring melioidosis, our findings suggest that it is not consistently associated with increased disease severity or mortality once infection occurs. These results should be interpreted cautiously given the limited number of included studies, heterogeneity across outcomes, and potential residual confounding. Further prospective studies are required to better define the underlying biological and healthcare-related mechanisms.