Timely effective antibiotic therapy and procedures for infectious source control significantly improved outcome.

<p>Administration of an effective antibiotic on the same day as the positive culture was taken significantly reduced all-cause mortality (p<0.001), as did undergoing a procedure for infectious source control (p<0.001).</p

Association between patient characteristics and outcome for 270 patients with <i>S. aureus</i> infection.

<p>Data are number (%) unless otherwise stated.</p>*<p>¹p value for the comparison between all-cause deaths and survivors.</p>*<p>²Denominator for occupation is number of patients over the age of 16 years which is given in each square.</p>*<p>³Past medical history of any underlying chronic medical conditions reported by the patient/relative or recorded in the medical notes.</p>*<p>⁴Immunosuppression from HIV (5 untreated, 3 on anti-retroviral therapy), chemotherapy (n = 3), untreated leukaemia (n = 1), radiotherapy (n = 1) or immunosuppressive medication including prednisolone more than 30 mg/day for more than 1 week (n = 17).</p>*<p>⁵Renal disease included end stage renal failure on long-term dialysis (n = 3; 2 on haemodialysis, 1 on peritoneal dialysis) and chronic renal failure (not on dialysis) due to diabetes mellitus (n = 14), systemic lupus erythematosus (n = 1), multiple myeloma (n = 1), glomerulonephritis (n = 1) or an unknown aetiology (n = 5).</p>*<p>⁶Cardiac disease comprised congenital heart disease (n = 4), valvular heart disease including rheumatic heart disease (n = 8), ischaemic heart disease (n = 8), or arrhythmias including heart block requiring pacemaker (n = 4).</p>*<p>⁷Lung disease comprised previously treated tuberculosis (n = 9), previous empyema (n = 1), lung cancer (n = 2), long-term tracheostomy (n = 1), chronic obstructive pulmonary disease (n = 2) or asthma (n = 1).</p

The range of sites of infection in patients and outcome associated with each clinical presentation.

*<p>¹p value for the comparison between all-cause deaths and survivors.</p>*<p>²Site of deep abscesses were muscle (n = 20), retroperitoneal space (n = 7), parotid gland (n = 7), liver (n = 3), lung (n = 2), epidural space (n = 2), eye (n = 2), oropharynx (n = 2) and spleen (n = 1).</p>*<p>³Other skin and soft tissue infections includes: necrotising fasciitis (n = 9), bedsore(s) (n = 6), pustules and carbuncles (n = 5), infected wound from trauma (n = 3), infected wound from tophi (n = 2), gangrene (n = 2), cellulitis (without other skin or soft tissue lesion) (n = 2) and infection of exfoliated skin following a severe drug reaction (n = 2).</p>*<p>⁴Orthopaedic material includes: internal fixation metalwork (n = 8) and a hip replacement (n = 1).</p>*<p>⁵Intravenous devices were peripheral cannulas (n = 4), central catheters (n = 3) and an umbilical catheter (n = 1).</p>*<p>⁶Endocarditis from transthoracic echocardiographic evidence of vegetations (n = 7); 1 case clinically but died prior to echocardiogram.</p>*<p>⁷Other infections include: urinary tract infection (n = 3), tenosynovitis (n = 2), Lemierre's syndrome (n = 1) and corneal ulcer (n = 1).</p>*<p>⁸Post-operative infections include: mediastinitis (n = 4; 3 following mitral valve replacement and 1 after coronary artery bypass graft), meningitis from infected bone flap surgical wound (n = 1) and abdominal wound (n = 1).</p

Higher all-cause mortality associated with methicillin-resistant <i>S. aureus</i> (MRSA) but not with Panton-Valentine Leukocidin (PVL).

<p>Patients infected by MRSA had a greater all-cause mortality compared with patients infected by methicillin-susceptible <i>S. aureus</i> (MSSA) (p<0.001). Conversely, patients infected by PVL gene-positive <i>S. aureus</i> had a lower all-cause mortality compared with patients infected by PVL gene-negative <i>S. aureus</i> (p<0.001), an association that remained after adjustment for MRSA (p = 0.001).</p

Significant risk factors for mortality from <i>S. aureus</i> infection from multiple logistic regression analysis.

*<p>¹95% confidence intervals.</p>*<p>²p value from Likelihood ratio test.</p

Detection of purified CPS by antigen-capture ELISA.

<p>mAb 3C5 was used in the capture phase of the ELISA at the concentrations listed. Following a wash and blocking step, purified CPS was serially diluted across the microtiter plate at the concentrations listed. The wells were then washed and HRP-labeled mAb 3C5 was used in the indicator phase to detect captured CPS. The ELISA was performed in triplicate and mean values are plotted.</p

Prototype Active Melioidosis Detect (AMD) LFI.

<p>(A) Schematic of LFI components. (B) <i>B. pseudomallei</i> strain Bp82 colony grown on an agar plate was picked and suspended in 2 drops of lysis buffer. The lysate was added to the sample pad followed by three drops of LFI chase buffer (top LFI). The LFI was imaged following a 15 min run time. The same test condition were used with a colony of <i>E. coli</i> (bottom LFI).</p

Calculation of mAb 3C5 affinity for CPS.

<p>A BIAcore X100 instrument was used to determine the affinity of mAb 3C5 for CPS. Biotinylated CPS was immobilized on the surface of a streptavidin sensor chip. Samples (two-fold serial dilution of mAb 3C5 [333–5.2 nM]) were injected over the sensor surface for 60 s, after which the mAb was allowed to passively dissociate for 120 s (left panel). The dissociation constant (K_D) was determined using the steady-state model in BIAevaluation software (right panel).</p

Active Melioidosis Detect analytical reactivity and specificity.

<p>*Indicates strains that were tested for reactivity against mAb 3C5 via western blot.</p

Prototype AMD LFI for detection of <i>B. pseudomallei</i> CPS in melioidosis patient samples.

<p>(A) Preliminary testing of a variety of archived patient samples from Australia and Thailand. (B) Detection of CPS in melioidosis patient urine samples (filtered) listed in <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002727#pntd-0002727-t002" target="_blank">Table 2</a>. Urine (50 µl) was combined with 100 µl of chase buffer and applied to the sample pad. Note that samples that were positive by antigen-capture immunoassay (<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002727#pntd-0002727-t002" target="_blank">Table 2</a>) were also positive by LFI and the levels of CPS detected between both assays are congruent.</p