Hospital-based prevalence of culture-confirmed melioidosis among high-risk patients in India, 2023–25: a multicentre prospective study

Abstract

BACKGROUND: Melioidosis is not a nationally notifiable disease in India, and the absence of systematic surveillance has contributed to substantial under-recognition and fragmented epidemiological data. We aimed to determine the hospital-based prevalence of culture-confirmed melioidosis among hospitalised adults at high risk of melioidosis in India. METHODS: We conducted a prospective, multicentre, hospital-based prevalence study between Jan 1, 2023, and Dec 31, 2025, across 15 tertiary care centres in India. Adults (aged ≥18 years) hospitalised with predefined community-acquired infectious syndromes and diabetes or chronic kidney disease were enrolled. Melioidosis was defined by culture confirmation. The primary outcome was hospital-based prevalence. Prespecified secondary analyses assessed geographical, syndrome-specific, and seasonal variation; factors associated with melioidosis; and clinical characteristics and in-hospital outcomes. FINDINGS: Among 2953 patients, 262 (8·9% [95% CI 7·9-10·0]) had culture-confirmed melioidosis, with marked geographical heterogeneity. Prevalence was highest in Odisha, Madhya Pradesh, and Karnataka, and among patients presenting with extrapulmonary abscesses and bone and joint infections. Cases clustered during the monsoon months. Factors independently associated with melioidosis included monsoon admission (adjusted odds ratio 1·40 [95% CI 1·08-1·83]), male sex (2·33 [1·64-3·32]), outdoor high-risk occupation (1·94 [1·47-2·56]), and groundwater as the primary drinking-water source (3·25 [2·48-4·26]). Bacteraemia occurred in 152 (58%) of 262 patients with melioidosis, and 50 (19%) died in hospital. INTERPRETATION: Melioidosis is a frequent and severe infection among high-risk hospitalised adults in India, with substantial geographical variation and strong environmental and seasonal associations. These findings support targeted diagnostic testing and heightened clinical awareness among high-risk patients. FUNDING: Indian Council of Medical Research.

The authors' abstract, as published at the source. The Lancet Global Health, 2026 · DOI ↗