M elioidosis, an infection caused by Burkholderia pseudomallei, remains an underrecognized disease, especially in children, in many locations to which it is endemic (1,2). Diverse clinical manifestations and intrinsic resistance to many antimicrobial drugs used for empirical treatment of sepsis contribute to high mortality rates (2-4). Conventionally, antimicrobial drug therapy for melioidosis comprises 2 phases: intravenous treatment for >10 days, followed by a prolonged, oral, eradication phase for a minimum of 12 weeks (5,6). Localized cutaneous disease might be treatable with oral agents alone, but adherence with eradication therapy is often diffi cult to achieve (4,5,7-9). We report trends in management and outcomes of melioidosis over 10 years at a nongovernmental pediatric hospital in northern Cambodia. The Study This study was approved by the hospital institutional review board (AHC IRB 979-14; 1044-15) and the Oxford Tropical Medicine Research Ethics Committee (OxTREC 550-14). Data on all culture-confi rmed case-patients who had B. pseudomallei infection during January 1, 2009-December 31, 2018, were collected retrospectively (2009-2013) and prospectively as part of an invasive bacterial infection surveillance study. Retrospective case-patients (the fi rst 173 case-patients) have previously been described and are included to illustrate trends over the decade (2). Retrospective case-patients were identifi ed by searching laboratory logbooks and databases, which were cross-checked against the hospital electronic patient information system. Data were extracted onto a standardized case report form, which was also adapted for contemporaneous capture of prospective casepatients. Repeat searches of the databases were conducted at the end of the study (Appendix Figure 1, https://wwwnc.cdc.gov/EID/article/27/4/20-1683-App1.pdf). The study site, microbiology specimen processing, and case defi nitions have been described elsewhere (2,8). We provide the statistical methods used (Appendix). Severe undernutrition was defi ned as a weight-forage z-score <-3. Approximately half (57.5%, 255/355) the children with melioidosis were male, and most (82.8%, 294/355) were brought for treatment during the wet season (Appendix Figure 2). Median age was 5.7 years (interquartile range 3.1-9.5 years). Concurrent conditions were infrequent (14/355, 3.9%). Parotitis was the most common manifestation (27.3%, 97/355) (Table 1). Hospital guidelines (introduced in 2012) recommend obtaining blood, throat swab and urine specimens for culture for all patients who have suspected melioidosis. However, blood was collected for culture for only 157 (44.2%) of 355 case-patients, a throat swab specimen for 31 (8.7%) of 355, and a urine sample for 16 (4.5%) of 355. Use of microbiological testing improved over time (Appendix Table 5, Figure 3). Of those who had blood cultured, 46.5% (73/157) were