Mortality among hospitalized children with melioidosis in Thailand: a retrospective national database analysis (2015-2023).

Background: Pediatric melioidosis remains under-characterized nationally in Thailand, hindering triage and critical-care planning. We quantified epidemiology, complications, and mortality correlates among hospitalized children. Methods: Retrospective analysis of Thailand's National Health Security Office database from January 2015 to Dec 2023, including patients <18 years with principal melioidosis. Incidence and case-fatality rate were calculated. Mortality-related clinical characteristics were compared using descriptive statistics. Findings: Among 5044 admissions, 58.3% were male and 80.5% from the Northeast; annual incidence ranged 3.7-5.8 per 100,000, peaking in 2023. Median length of hospital stay was 11 days. Lower respiratory tract infection was the commonest localized focus (17.6%), followed by septic shock (2.9%). Organ dysfunction consisted of acute respiratory failure 3.2%, acute renal failure 2.3%, and disseminated intravascular coagulation (DIC) 1.7%. There were 2.3% required intubation with mechanical ventilation >96 h, and 2.2% needed renal replacement therapy. Overall, 84 children died (1.7%); deaths clustered in tertiary hospitals (71.4%). Mortality was markedly higher among children with septic shock, lower respiratory tract infection, and acute respiratory failure compared with children without these complications. Interpretation: National data identify a Northeast-weighted pediatric burden and a high-risk trajectory from pneumonia to acute respiratory failure, shock, and DIC. Embedding pediatric sepsis bundles with early melioidosis-active therapy and seasonal pediatric intensive care unit (PICU) surge/transfer protocols, may shorten time-to-treatment and reduce deaths substantially and equitably. Funding: This study was supported by the Fundamental Fund, Khon Kaen University, Thailand.