Distinguishing Kingella kingae from Pyogenic Acute Septic Arthritis in Young Portuguese Children

Abstract

(1) Background: We aim to identify clinical and laboratorial parameters to distinguish Kingella kingae from pyogenic septic arthritis (SA). (2) Methods: A longitudinal, observational, single-centre study of children < 5 years old with microbiological positive SA admitted to a paediatric hospital from 2013–2020 was performed. Clinical and laboratorial data at admission and at 48 h, as well as on treatment and evolution, were obtained. (3) Results: We found a total of 75 children, 44 with K. kingae and 31 with pyogenic infections (mostly MSSA, S. pneumoniae and S. pyogenes). K. kingae affected younger children with low or absent fever, low inflammatory markers and a favourable prognosis. In the univariate analyses, fever, septic look, CRP and ESR at admission and CRP at 48 h were significantly lower in K. kingae SA. In the multivariate analyses, age > 6 months ≤ 2 years, apyrexy and CRP ≤ 100 mg/L were significative, with an overall predictive positive value of 86.5%, and 88.4% for K. kingae. For this model, ROC curves were capable of differentiating (AUC 0.861, 95% CI 0.767–0.955) K. kingae SA from typical pathogens. (4) Conclusions: Age > 6 months ≤ 2 years, apyrexy and PCR ≤ 100 mg/L were the main predictive factors to distinguish K. kingae from pyogenic SA < 5 years. These data need to be validated in a larger study.

Osteoarticular Infections: Younger Children With Septic Arthritis and Low Inflammatory Patterns Have a Better Prognosis in a European Cohort

“…25 Our work supports the impression that these factors affect prognosis in both ASA and AHO infections. Interestingly, these risk factors for ACC and sequelae are similar to our previously published K. kingae prediction risk factors for ASA <5 years, 26 where apyrexy and polymerase chain reaction ≤100 mg/L, together with age >6 months and ≤2 years, were used to distinguish K. kingae from pyogenic infections. Undeniably, K. kingae infections were an important proportion of low-risk OAI, mainly ASA infections, in our cohort, as shown by our shorter IV antibiotic courses and by restricting invasive bone procedures in these infections.…”

Osteoarticular Infections in Children: Accurately Distinguishing between MSSA and Kingella kingae

“…In a recently published study, Gouveia at al. demonstrated that age ≥ 6 months but ≤2 years, apyrexy and CRP ≤ 100 mg/L was a better model to distinguish K. kingae SA from classic pathogens in children <5 years of age, with an overall PPV of 86.7%, 88.6% for K. kingae and 83.9% for pyogenic infections [ 31 ]. However, it is important to emphasize that the collective of the patients was much smaller in that study (75 children), and that only 11 OAIs were due to MSSA [ 31 ].…”

Minimally invasive management of pediatric osteoarticular infections

“…However, in recent years Kingella kingae has been described as the main causative agent of OAI in children aged 6-48 months (4). K. kingae OAI are usually characterized by a mild clinical presentation, minor increase in biological markers, and a better outcome than those caused by other bacteria, especially S. aureus (5). Children with S. aureus OAI tend to be older, have an associated fever, and a marked rise in acute phase reactants levels and white blood cell counts (5,6).…”

“…K. kingae OAI are usually characterized by a mild clinical presentation, minor increase in biological markers, and a better outcome than those caused by other bacteria, especially S. aureus (5). Children with S. aureus OAI tend to be older, have an associated fever, and a marked rise in acute phase reactants levels and white blood cell counts (5,6). Likewise, methicillin-resistant S. aureus (MRSA) OAI has been related to severe purulent complications, increased probability of secondary-procedure, and a significantly higher admission rate to the intensive care unit (7,8).…”