Prospective survey of acute osteoarticular infections in a French paediatric orthopedic surgery unit

Abstract

The epidemiology of acute paediatric osteoarticular infections (OAI) has recently evolved, mainly due to the improvement of microbiological diagnosis. We conducted a prospective study to analyse the recent epidemiology and the clinical evolution of paediatric OAI in order to validate the adequacy of our probabilistic first-line antibiotic treatment (intraveinous cefamandole + gentamicin). All children suspected of community acquired OAI were included and followed-up for 3 years. The etiologic diagnosis was based on blood cultures, joint aspirations and bone punctures. All osteoarticular (OA) samples were systematically inoculated into blood culture bottles. Realtime universal 16S rRNA and PCR targeted on Staphylococcus aureus, Kingella kingae, Streptococcus pneumoniae and Streptococcus pyogenes were performed twice a week. septic arthritis, 70 osteomyelitis, 23 osteoarthritis and six spondylodiscitis were analysed. A portal of entry was suspected in 44% of cases, including 55% of otorhinolaryngological infections.C reactive protein was the most sensitive inflammatory marker. PCR increased by 54% the performance of bacteriological diagnosis.Among the patients completely investigated (blood culture and OAI samples), there were 63% documented OAI. The main pathogens found were K. kingae (52%), S. aureus (28%), S. pyogenes (7%), S. pneumoniae (3%) and Streptococcus agalactiae (2%). All isolated bacteria were sensitive to the probabilist treatment and outcome was favorable. PCR has significantly improved the performance and the delay of IOA diagnosis in children, for which K. kingae turned out to be the first causative agent. The probabilistic treatment was active against the main bacteria responsible for paediatric OAI.

Community-acquired bone and joint infections in children: a 1-year prospective epidemiological study

“…Although 24 of all the reviewed cases had specific radiological signs of BJI, only 9 had a positive microbiological culture and were considered definitive diagnoses 15. Our low rate of microbiological identification by standard cultures, similar to the findings in the UK and elsewhere,6 8 20 21 is probably due to the absence of microbiological testing in some patients, the difficulty of growing micro-organisms from bone or joint samples,20 and the absence of PCR for K. kingae detection at that time in our laboratory, which would have increased our rate of microbial identification 22…”

Aetiology of arthritis in hospitalised children: an observational study

“…However, following the development of molecular techniques, more recent studies have described K. kingae , a Gram-negative coccobacillus, as the primary pathogen of arthritis, especially in children under 4 years of age 9 10 12 28. In our study, the most common pathogen among 75 children with proven septic arthritis was K. kingae (69% of cases).…”

Molecular detection of oropharyngeal Kingella kingae in children and its correlation with osteoarticular infections and oncology diseases in Basrah, Iraq

“…(4 cases of septic arthritis and 14 cases of osteomyelitis) of OAI in this study, while (Al-Qwbani et al, 2016) found that the K. kingae is the cause of OAI in majority of cases (septic arthritis 73.1%, osteomyelitis 15.7%, spondylodiscitis 5.4%). A study by Ferroni showed 76.1% of OAI due to K. kingae, while 52.9% of osteomyelitis cases were due to K. kingae in children less than 4 years (Ferroni et al, 2013), this might be attributed to that the patient with Kingella kingae septic arthritis have mild presentation and fewer complication and may not reach to hospital (Basmaci et al, 2011). In addition, septic arthritis cases in this study were few (three) and majority of cases were osteomyelitis (73% of OAI cause by Kingella kingae are septic arthritis) (Al-Qwbani et al, 2016) Another point, child with skeletal system infection in this study were sampled in winter months while K. kingae infection mostly in autumn.…”