There were a total of 314 adult patients admitted during the study period with suspected or culture-positive melioidosis, of whom 230 (73%) were recruited to this study. The first scan was undertaken within 48 or 72 hours of recruitment in 72% (166/314) and 86% (198/314) of cases, respectively. One or more SP600125 chemical structure abscesses were identified in the liver and/or spleen in 77/230 (33%) cases, 5 of who also had ultrasound evidence of abscesses at other sites (kidney, 2; prostate,

1; pancreas, 1; adrenal gland, 1). One or more abscesses were present in the liver alone in 20/77 (26%), in the spleen alone in 33/77 (43%), and in both organs in 24/77 (31%) cases. Abscesses were noted to be multiple in 31/44 (70%) and 50/57 (88%) of cases with liver and splenic

abscesses, respectively. No patient developed an abscess that became clinically apparent after an initial negative scan during this study. The higher frequency of splenic abscesses and the presence of multiple abscesses are consistent with previous reports.3 This rate of abscess detection by ultrasound is considerably lower than the rates determined during retrospective studies in Thailand using the same imaging technology, but is more closely consistent with our clinical experience. Our findings are higher than the reported rate of intra-abdominal abscess (including splenic, liver, kidney and adrenal) in Australia of 12%.4 However, the incidence of prostatic abscess in this study was lower than previously reported in northern Australia.4

Of the 230 patients, 69 (30%) were culture-positive from blood, of whom 26 (38%) had an intra-abdominal abscess. There Bleomycin mw was no relationship between the presence of bacteraemia and the occurrence of intra-abdominal abscess (p = 0.29). Characteristics of patients with or without abscesses on ultrasound scan are compared the in Table 1. Patients with one or more abscesses on ultrasound were younger, had a higher rate of known renal disease, and were more likely to have abdominal pain and a palpable liver and/or spleen compared with patients who had a negative ultrasound scan. Abscesses were cryptic, however, in around three-quarters of cases. This provides support for the use of ultrasound scanning (or other imaging) of all patients with melioidosis. Incision and drainage was performed in 16 cases with large solitary abscesses. Splenectomy was performed in two cases with multiple splenic abscesses not amenable to surgical or radiologically-guided drainage. Length of stay was comparable between the patients with and without intra-abdominal abscesses (9 days [IQR 4–15 days] vs 10 days [IQR 5–19 days], p = 0.93). The mortality rate at 4 weeks post-discharge was lower in patients who were abscess positive than in patients without intra-abdominal abscesses detected (8/77 [10%] vs 31/153 [20%]), although this did not reach statistical significance (p = 0.06).