While this is an interesting concept directly correlating bacterial
burden with clinical outcome, its applicability in resource
limited settings is doubtful because of the cost factor. In a
retrospective epidemiological study, Lee etal[57] describes
absence of an eschar, higher APACHE II scores and an event
of ICUadmission as independent risk factors associated
with fatality (n=297, deaths=18). This shows a conflict in
evidence with the previous study by Sonthayanon et al, who
showed that the presence of an eschar was positively and
significantly correlated with higher DNAloads at admission
which in turn was associated with a fatal outcome. Due to
such conflicts in evidence, gaps in data and small sizes
of samples, it is difficult to establish clear prognostic
indicators. This is an area for further research