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

Ferroni, Agnès; Khoury, Hanane; Dana, Caroline; Quesne, Gilles; Berche, Patrick; Glorion, Christophe; Péjin, Zagorka

doi:10.1111/clm.12031

Cited by 92 publications

(45 citation statements)

References 26 publications

(37 reference statements)

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“…To our knowledge this is one of the largest studies on paediatric AHOM performed in Europe. Similar cohort studies have been previously conducted in Spain [14], and France [21], as well as in other extra-European countries including Israel [22], Thailand [23], Australia [3], and the United States [24]. …”

Section: Discussionsupporting

confidence: 65%

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.

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Section: Discussionsupporting

confidence: 65%

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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“…In a study in which conventional cultures, BacT/Alert BCVs, and real-time PCR with universal and pathogen-specific primers targeting the cpn60 gene were employed, K. kingae was implicated in 35 of 46 (76.1%) children younger than 4 years with septic arthritis and in 9 of 17 (52.9%) with osteomyelitis with or without associated joint invasion, and the organism was not detected in any of 20 older children with skeletal system infections (151). In a recent large study, 11 of 15 (73.3%) children with joint or bone infections were positive for K. kingae DNA sequences by broad-range PCR and later confirmed with species-specific primers, whereas the organism was not detected in any of 126 PCR-positive specimens from adult patients (152).…”

Section: Skeletal System Infectionsmentioning

confidence: 99%

“…Kingella kingae was detected by BCVs and/or NAA tests in 35 of 46 (76.1%) children aged Ͻ4 years with septic arthritis and in 9 of 17 (52.9%) children in the same age range with osteomyelitis or concurrent septic arthritis and osteomyelitis (151). The standard culture on solid medium failed to recover the organism in all 44 patients, while the BCVs were positive in only 5 specimens (including four exudates and one blood culture), and in 39 of the 44 patients (88.6%) K. kingae infection was diagnosed by NAA only (151).…”

Section: Detection By Nucleic Acid Amplification Assaysmentioning

confidence: 99%

Kingella kingae: Carriage, Transmission, and Disease

2015

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SUMMARY Kingella kingae is a common etiology of pediatric bacteremia and the leading agent of osteomyelitis and septic arthritis in children aged 6 to 36 months. This Gram-negative bacterium is carried asymptomatically in the oropharynx and disseminates by close interpersonal contact. The colonized epithelium is the source of bloodstream invasion and dissemination to distant sites, and certain clones show significant association with bacteremia, osteoarthritis, or endocarditis. Kingella kingae produces an RTX (repeat-in-toxin) toxin with broad-spectrum cytotoxicity that probably facilitates mucosal colonization and persistence of the organism in the bloodstream and deep body tissues. With the exception of patients with endocardial involvement, children with K. kingae diseases often show only mild symptoms and signs, necessitating clinical acumen. The isolation of K. kingae on routine solid media is suboptimal, and detection of the bacterium is significantly improved by inoculating exudates into blood culture bottles and the use of PCR-based assays. The organism is generally susceptible to antibiotics that are administered to young patients with joint and bone infections. β-Lactamase production is clonal, and the local prevalence of β-lactamase-producing strains is variable. If adequately and promptly treated, invasive K. kingae infections with no endocardial involvement usually run a benign clinical course.

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“…31 Twenty-nine articles were considered relevant with respect to identifying the number of confirmed infections with K. kingae in bacteriologically proven musculoskeletal infections in children (Table 1). 2,22,28,29,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][66][67][68][69][70] This was further studied to summarize the frequency of K. kingae infections among children under 48 months old ( Table 2). Additional epidemiological data extracted and collated included musculoskeletal infection sites, gender, age and seasonality.…”

Section: Search Findingsmentioning

confidence: 99%

<p>Systematic Review of <em>Kingella kingae</em> Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies</p>

Wong¹,

Williams²,

Cooper³

2020

PHMT

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Kingella kingae, a pathogen often responsible for musculoskeletal infections in children is the most common cause of septic arthritis and osteomyelitis in children 6 to 36 months of age. The aim of this study was to perform a systematic review of previous studies to determine the proportion of K. kingae in bacteriologically proven musculoskeletal infections among the pediatric population. A secondary objective was to describe the diagnostic strategies and outcome of patients with musculoskeletal infections caused by K. kingae. A systematic review was conducted to identify publications that report on musculoskeletal infections caused by K. kingae in the pediatric population (patients 0 to <18 years old with microbiologic culture and/or polymerase chain reaction (PCR) confirmation of K. kingae and a description of the musculoskeletal infection involved). Of 144 studies included in this review, we sought to determine the proportion of K. kingae pediatric musculoskeletal infections. A total of 711 (30.8%) out of 2308 pediatric cases with culture and/or PCR proven musculoskeletal infections had K. kingae successfully identified from twenty-nine studies. Of the 1070 patients who were aged less than 48 months, K. kingae was the organism identified in 47.6% of infections. We found the average age from the collated studies to be 17.73 months. Of 520 pediatric musculoskeletal patients in which K. kingae infections were identified and where the studies reported the sites of infection, a large proportion of cases (65%) were joint infections. This was followed by 18.4% osteoarticular infection (concomitant bone and joint involvement), with isolated bone and spine at 11.9% and 3.5%, respectively. Twenty-one papers reported clinical and laboratory findings in children with confirmed K. kingae infection. The median temperature reported at admission was 37.9°C and mean was 38.2°C. Fourteen studies reported on impact and treatment, with the majority of children experiencing good clinical outcome and function following antibiotic treatment with no serious orthopaedic sequelae.

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

Cited by 92 publications

References 26 publications

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Kingella kingae: Carriage, Transmission, and Disease

<p>Systematic Review of <em>Kingella kingae</em> Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies</p>

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