ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
This article is part of the Research TopicInfections in Hematology: Advances in Diagnosis, Management, and Prevention in Benign and Malignant DisordersView all 5 articles
Severe bacterial infection in thalassemia patients: prevalence, predisposing factors, causative organisms and outcomes
Provisionally accepted
Ruttanaporn Taya
Adisak Tantiworawit*Harit ThongwitokomarnSirichai SrichairatanakoolTeerachat Punnachet
Nonthakorn Hantrakun
Pokpong PiriyakhuntornThanawat RattanathammetheeSasinee HantrakoolChatree Chai-Adisaksopha
Ekarat RattarittamrongLalita Norasetthada
Piangrawee NiprapanKanda Fanhchaksai
Pimlak Charoenkwand- Chiang Mai University, Chiang Mai, Thailand
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Introduction: Thalassemia is one of the most common genetic blood disorders globally. Bacterial infections remain a major cause of death among affected patients. To determine prevalence, predisposing factors, causative organism, and outcomes of severe bacterial infection in thalassemia patients. Methods: This retrospective study analyzed data from the Thalassemia Registry of the Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University (September 2013-September 2023). Thalassemia patients aged > 15 years were included. Risk factors for severe bacterial infection were identified using multivariate logistic regression. Severe bacterial infection was defined as community-acquired involving a major organ, requiring parenteral antibiotics and/or surgery, and associated with a National Early Warning Score (NEWS) > 4. Results: A total of 208 patients were enrolled (mean age 45.3 ± 16.0 years; 62.0% female; 56.7% transfusion-dependent; 36.1% splenectomy). Severe bacterial infection occurred in 43 patients (20.7%). Primary bacteremia was the most common (23.2%), with Klebsiella pneumoniae (20.9%) and Escherichia coli (13.9%) as the leading pathogens. Infection-related mortality rate was 9.3%. Significant risk factors included hematocrit < 21% (OR = 3.15; 95% CI 1.32-7.50; p = 0.01), splenectomy > 10 years (OR = 2.46; 95% CI 1.07-5.69; p = 0.035), diabetes mellitus (OR = 10.42; 95% CI 2.21-49.12; p = 0.03), and liver hemochromatosis (OR = 3.76; 95% CI 1.64-8.63; p = 0.002). Conclusion: Severe bacterial infections affected 20.7% of thalassemia patients in this cohort, mainly bacteremia due to Klebsiella pneumoniae and Escherichia coli. Major risk factors were severe anemia, prolonged splenectomy, diabetes mellitus, and iron overload with liver hemochromatosis.
Keywords: Anemia, Bacterial Infections, Escherichia coli, Klebsiella pneumoniae, Thalassemia
Received: 27 Nov 2025; Accepted: 05 Feb 2026.
Copyright: © 2026 Taya, Tantiworawit, Thongwitokomarn, Srichairatanakool, Punnachet, Hantrakun, Piriyakhuntorn, Rattanathammethee, Hantrakool, Chai-Adisaksopha, Rattarittamrong, Norasetthada, Niprapan, Fanhchaksai and Charoenkwand. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Adisak Tantiworawit
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