Kingella kingae and Osteoarticular Infections

Abstract

OBJECTIVES: In this study, we aimed to contrast the bacteriologic epidemiology of osteoarticular infections (OAIs) between 2 patient groups in successive 10-year periods, before and after the extensive use of nucleic acid amplification assays in the diagnostic process. METHODS: Epidemiologic data and bacteriologic etiologies of all children presenting with OAIs on admission to our institution over 20 years (1997-2016) were assessed retrospectively. The population was divided into 2 cohorts, using the standardized use of polymerase chain reaction as the cutoff point (2007). The conventional cohort included children with OAIs mainly investigated by using classic cultures, whereas the molecular cohort referred to patients also investigated by using molecular assays. RESULTS: Kingella kingae was the most frequently isolated pathogen, responsible for 51% of OAIs, whereas other classic pathogens were responsible for 39.7% of cases in the molecular cohort. A statistically significant increase in the mean incidence of OAIs was observed, as was a decrease in the mean age at diagnosis after 2007. After 2007, the pathogen remained unidentified in 21.6% of OAIs in our pediatric population. CONCLUSIONS: Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between 6 and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriologic etiology of OAIs.

Osteomyelitis in a General Pediatric Ward

“…After admission, apyrexy was achieved on day 2.4 ± 1 [1][2][3][4]. Resolution of local signs of inflammation and impaired function were seen on day 7.1 ± 2.3 [3][4][5][6][7][8][9][10][11][12][13].…”

“…3 Kingella kingae (K. kingae) plays a major role in children under four years old. 3,5,9 In a recent systematic review, Maria Wong et al 10 found a 30.8% prevalence of K. kingae osteoarticular infections in the paediatric population, with a significant increase under 48 months of age (47.6%). 10 Considering children with hemoglobinopathies SS or SC and those in developing countries, Salmonella species are an important cause of AO.…”

Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis?

“…In the second group, where the molecular technique was used extensively, Kingella kingae was the most frequently isolated pathogen (51% of the confirmed cases) with an increase especially in children aged 6 to 48 months. Of note, the molecular technique overall improved the detection of the bacteria responsible for the infection, with 78.4% of identified cases compared to 59.4% during the first conventional period [7]. Pseudomonas aeruginosa and Streptococcus pyogenes could be responsible for infection after a trauma or surgery, while Salmonella spp.…”

Long-Term Outcomes of Acute Osteoarticular Infections in Children

“…Previous studies on long-term outcomes of OM and SA mostly referred to pre-millennial patient cohorts. During the last two decades, management of osteoarticular infections in children has advanced with increasing use of magnetic resonance imaging (MRI), microbial testing (i.e., nucleic acid amplification and resistance testing) and recommendations for shorter treatment duration (17)(18)(19)(20)(21)(22)(23). Clearly, long-term outcome studies evaluating modern management are needed.…”