Co-Infections and Their Prognostic Impact on Melioidosis Mortality: A Systematic Review and Individual Patient Data Meta-Analysis.

Objectives: This study aimed to evaluate the prognostic impact of coinfections and other clinical factors on mortality in melioidosis patients, providing a comprehensive analysis through systematic review and meta-analysis. Methods: A systematic search was conducted in PubMed, Embase, Scopus, and other sources for studies published from their inception to August 2023. Studies reporting mortality outcomes in melioidosis patients with and without coinfections were included. Mixed-effects logistic regression models were used to estimate the causal association of each prognostic factor on the outcome. Directed acyclic graphs (DAGs) were used to guide confounding adjustment, and missing data were handled using multiple imputations. Results: A total of 346 studies involving 509 patients were analyzed. Coinfections were observed in 10.8% of patients with tuberculosis and Leptospira spp. being the most common. Disseminated disease significantly increased the odds of death (OR 4.93, 95% CI: 2.14-11.37, p < 0.001). Coinfections were associated with a higher mortality rate, but the association was not statistically significant (OR 2.70, 95% CI: 0.53-13.90, p = 0.172). Sensitivity analyses confirmed the robustness of the findings. Other factors, including diabetes mellitus and agricultural occupation, were evaluated for their associations with mortality. Conclusions: Disseminated melioidosis remains a significant factor influencing prognosis. Although less common, coinfections may contribute to worsen patient outcomes, emphasizing the importance of immediate and accurate diagnosis and comprehensive management.