Bacterial aetiology of acute osteoarticular infections in children

Abstract

Aim: To study the bacterial aetiology of acute osteoarticular infections in children and to analyse the efficiency of culture methods. Methods: Bacteriological data of 407 cases of clinically suspected osteoarticular infections affecting 406 children hospitalized in an orthopaedic surgery department between 1999 and 2002 were retrospectively reviewed. Results: Bacterial cultures from clinical specimens were positive in 74 cases (18%): 38 cases of septic arthritis and 36 cases of bone infections (osteitis, osteomyelitis or osteoarthritis). The use of liquid medium bottles to grow bacteria from articular fluids increased the rate of positive cultures compared to the use of standard solid media (p=0.0001). The most commonly recovered pathogen was Staphylococcus aureus (44%) followed by Kingella kingae (14%), Streptococcus pyogenes (10%) and Streptococcus pneumoniae (10%). K. kingae was most frequently isolated among children under 36 mo of age (p=0.0003), whereas S. aureus was most frequently isolated among children over 36 mo (p=0.0015). Conclusion: By improving our culture method, we observed a recrudescence of isolation of K. kingae, but S. aureus remains the main pathogen isolated from osteoarticular infections in children. This finding is useful for the adaptation of a probabilistic antibiotic treatment of these infections.

Specific Real-Time Polymerase Chain Reaction Places Kingella kingae as the Most Common Cause of Osteoarticular Infections in Young Children

“…Several authors now consider that the detection of bacterial DNA in an OAI sample provides conclusive evidence that the relevant species is responsible, even if culture is negative. 6,7,10 The main demographic and clinical characteristics of the 39 cases of K. kingae OAI diagnosed here are in keeping with previous reports. 20 -27 In particular, patients with K. kingae infection had a median age of 14.6 months, confirming the higher prevalence of this bacterium in infants and very young children; S. aureus was the most frequent species identified in children older than 3 years (median age 8.5 years).…”

The limping child: an algorithm to outrule musculoskeletal sepsis

“…It requires aggressive antibiotic treatment and urgent joint aspiration or surgical drainage. The most common pathogens are S. aureus, including methicillin resistant S. aureus (MRSA) in some series [9]; Streptococcus pyogenes; Streptococcus pneumoniae; Salmonella species; and Kingella kingae [9][10][11]. Early diagnosis and treatment are more important than the actual method of drainage of the septic joint [12].…”

Osteoarticular Infections in Children

“…12 Depending on the study, peak age of infection ranges from less than 2 years to 6 years, with isolated septic arthritis and K kingae infections occurring at younger ages, and osteomyelitis and S aureus occurring at older ages. 5,9,[12][13][14] Clinical correlation (Fig. 3) -Distribution of osteoarticular infections.…”

“…Specifically, S aureus, methicillin susceptible (MSSA) and methicillin resistant (MRSA), have been the most commonly cultured organisms during the past 4 decades. 9,10 Before an effective vaccine, Haemophilus influenzae, type B, was the second most common cause of ABA, 10 although it is now rarely reported in well-immunized populations. Kingella kingae is an oral gram-negative bacterium, and descriptions of this fastidious organism causing ABO and ABA have been increasingly common because of better culture techniques, inoculating sterile body fluids into blood culture bottles, and advancing molecular techniques.…”