Medical Journal of Malaysia

MJM, Vol 70 Supplement 1 September 2015

An outbreak of post arthroscopic melioidosis knee abscess in private hospital – Selangor, Malaysia 2012

Harishah T*, Rosemawati A**, Fadzilah K**, Rohani I***

*Selangor State Health Department, Malaysia, **Epidemic Intelligence Program, Ministry of Health Malaysia, ***Kuala Lumpur Federal Territory Health Department, Malaysia


Introduction: Melioidosis is an infectious disease caused by gram-negative bacterium Burkholderia pseudomallei (Bp). It is a free living saprophyte in the soil and can directly enter into the bloodstream via minor wounds or skin abrasions. On 13th July HL District Health Office received notification from ‘A’ Hospital regarding three cases of melioidosis among persons who had undergone similar arthroscopic procedures. The aim of this study was to describe the outbreak epidemiologically and recommend future preventive measures. 

Methods:  Case control study was performed to determine the risk factors for post arthroscopic melioidosis knee abscess. Face to face interview using standard format questionnaire was carried out among all patients who underwent knee arthroscopic operations since June 2012 in Hospital “A”. Cases were defined as patients who underwent an arthroscopy operation from Hospital ‘A’ since June 2012 and develops post-operative complication that tested positive for Bp. Odds ratio (OR) was calculated with 95% confident interval (95% CI).

Results: Out of 34 exposed patients, 22 were confirmed (64.5%) with one death (CFR 4.5%). Majority were male (68%), Malays (91%) and mean incubation period was three (SD2.5) days. Higher incidence rate was seen among teenager (54%) and above 50 years old (50%). There was no risk associated with concurrent infection. Risk assessment showed substandard method of sterilisation performed by the nurses and the instrument was used repeatedly for difference patients without time lag. Environmental sampling was negative for Bp but instrument’s swab were positive for Bp. Genetic study of Bp showed 100% similarity between cases.

Conclusion: Post arthroscopic melioidosis knee abscess is associated with substandard method of sterilisation technique and sharing of contaminated instrument during operation.  Training on proper practice of equipment’s decontamination was conducted. Following this incident supervisors are closely monitoring their staff to prevent similar problem in the future.

Keywords: Melioidoisis, arthroscopy, sterilisation