Objective To analyze the clinical characteristics, treatment, and outcomes of patients with bloodstream infection of Burkholderia pseudomallei (Bp) in grade II hospitals in Ledong and Changjiang of Hainan province, and provide reference for primary healthcare diagnosis and treatment.

Methods The clinical data of 78 patients with bloodstream infection of Bp admitted to three local grade II hospitals between January 2020 and December 2024 were collected, including their basic information, clinical manifestations, drug susceptibility test results, and outcomes. Statistical analysis was performed by using software SPSS 22.0, and intergroup comparisons were conducted by using χ² test.

Results In the 78 patients, 71 were men (91.03%), and 68 were farmers (87.18%). The cases in age group 41–50 years (28 cases, 35.90%) accounted for the highest proportion, and the cases mainly occurred during August - October (46 cases, 58.97%). 55 patients (70.51%) had diabetes. The main clinical manifestations included acute onset, short course, and fever (68 cases, 87.18%) . The inflammatory markers level, including neutrophil percentage and C-reactive protein (CRP), were increased, while the prealbumin levels generally decreased. Common imaging findings included pulmonary inflammation (58 cases, 74.36%), liver abscess (20 cases, 25.64%), and splenic abscess (17 cases, 21.79%). Comparisons between the survival and death groups showed significant differences in the use of recommended antibiotics (χ²=3.890, P<0.05), complication of septic shock (χ²=4.792, P<0.05), liver abscess (χ²=3.885, P<0.05), multiple infections (χ²=7.535, P<0.05), and the length of hospital stay (χ²=7.330, P<0.05). In the 78 patients, 44 were cured or improved (56.41%), 9 experienced recurrence (11.54%), and 25 died (32.05%).

Conclusion In typhoon or rainy season in tropical Hainan, it is necessary to pay close attention to the bloodstream infection of B. pseudomallei in male agricultural workers with diabetes, unexplained fever and significantly elevated levels of inflammatory markers. Primary care physicians should perform blood culture for the disease confirmation as early as possible. For the patients complicating with liver abscess or multiple infections, active treatment with recommended antibiotics is essential to improve prognosis.