Bacterial aetiology of acute osteoarticular infections in children

Moumile, Kaoutar; Merckx, Jacques; Glorion, Christophe; Jc, Pouliquen; Berche, Patrick; Ferroni, Agnès

doi:10.1080/08035250410023278

Cited by 110 publications

(54 citation statements)

References 10 publications

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“…Since the adoption of conjugate vaccination programs, a rapid drop in the incidence of H. influenzae type b arthritis has occurred (154,155), whereas K. kingae has emerged as the most common etiology of joint infections in children 6 months to 3 years of age (13,14,16). Although the mutual relationships (competition, symbiosis, etc.)…”

Section: Skeletal System Infectionsmentioning

confidence: 99%

“…The number, however, has sharply increased in recent years, jumping to 105 in the following decade and 83 in the short period from January 2010 through August 2014 (determined by a PubMed search with "Kingella kingae" and "Moraxella kingii"), and has firmly established the status of K. kingae as a common agent of bacteremia with no focus (also called occult bacteremia) (11,12) and the predominant etiology of joint and bone infections in 6-to 36-month-old children (13)(14)(15)(16). This increasing detection of K. kingae does not indicate that the bacterium is really a novel human pathogen.…”

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confidence: 99%

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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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Section: Skeletal System Infectionsmentioning

confidence: 99%

mentioning

confidence: 99%

Kingella kingae: Carriage, Transmission, and Disease

2015

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“…Samples from the infected bone or joint require an invasive procedure but are more likely to be positive (40-50% positive) than blood cultures (9-22% positive). 15,27 Yield is generally not high for identification of a bacteria in children with OM, 27 as, unless therapeutic operative intervention is required, bone biopsy is infrequently necessary for diagnostic reasons alone.…”

Section: Microbiological Investigationmentioning

confidence: 99%

“…Neonatal vascular anatomy allows infection within the bone to reach the growth plate or joint in 76% of neonatal osteomyelitis cases. 13 The pathogens implicated in paediatric bone and joint infections commonly include meticillin-sensitive Staphylococcus aureus (MSSA) (44-80%) 8,14,15 and Kingella kingae (14-50%; higher in children aged < 36 months) 8,[15][16][17][18][19] and more rarely meticillin-resistant S. aureus (MRSA) (rare in the UK but found in 40-50% of cases in the USA), 20,21 Panton-Valentine leukocidin (PVL) MSSA, 22,23 group A Streptococcus (GAS), group B Streptococcus (GBS) (neonates), 12,24 non-typeable Haemophilus spp. (incidence unknown), Haemophilus influenzae type b (in non-immunised or immunodeficient children), Escherichia coli (neonates), 12,24 Streptococcus pneumoniae 25 and coagulase-negative Staphylococcus (subacute).…”

Section: Osteomyelitis and Septic Arthritis In Childrenmentioning

confidence: 99%

Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study

Sukhtankar

Arch

Ahmad

et al. 2017

Health Technol Assess

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Declared competing interests of authors: Saul N Faust was UK chief investigator and University Hospital Southampton NHS Foundation Trust principal investigator for a Cubist-sponsored clinical trial of daptomycin against standard of care antibiotic therapy in paediatric osteomyelitis. All funds were paid into accounts within the NHS trust or university and not paid as personal fees. He reports consultancy fees for advisory board participation paid into accounts within the NHS trust or university (not personal fees) from vaccine manufacturers and antimicrobial agent manufacturers, including AstraZeneca, Cubist, Merck, GlaxoSmithKline (GSK) and Pfizer, outside the submitted work. He acts as principal investigator for clinical trials and other studies conducted on behalf of University Hospital Southampton NHS Foundation Trust/ University of Southampton that are sponsored by vaccine manufacturers and antimicrobial agents, and has participated in advisory boards for vaccine manufacturers. Adam Finn reports grants and personal fees from Sanofi Pasteur MSD Ltd (SPMSD), and grants and personal fees from GSK, outside the submitted work. In addition, prior to October 2014, the University of Bristol and University Hospitals Bristol NHS Foundation Trust received funding for research conducted by Adam Finn and for consultancy and lectures from Pfizer, GSK, SPMSD and Novartis, who manufacture licensed and developmental meningococcal vaccines. Stuart C Clarke acts as principal investigator for clinical trials and other studies conducted on behalf of University Hospital Southampton NHS Foundation Trust/University of Southampton that are sponsored by vaccine manufacturers but receive no personal payments from them. He has participated in advisory boards for vaccine manufacturers and has received financial assistance from vaccine manufacturers to attend conferences, but receives no personal payments for this work. All grants and honoraria are paid into accounts within the respective NHS trusts or universities. Jethro Herberg reports that he was an investigator for a Cubist-sponsored clinical trial of daptomycin against standard of care antibiotic therapy in paediatric osteomyelitis; he received no personal payments. Andrew Riordan reports that the trust, but not he, has received funding for research sponsored by vaccine manufacturers and antimicrobial agents. He was lead editor for an e-learning package on meningitis produced by the Royal College of Paediatric and Child Health, funded by an unrestricted grant from Novartis Vaccines. Marieke Emonts was Newcastle upon Tyne Hospitals Foundation Trust's principal investigator for a Cubist-sponsored clinical trial of daptomycin against standard of care antibiotic therapy in paediatric osteomyelitis. All grants and honoraria are paid into accounts within the NHS trust or university; she received no personal payment of any kind. Marieke Emonts reports acting as site principle investigator on behalf of the Newcastle upon Tyne Hospitals Foundation Trust/Newcastle University for clinical tr...

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“…The diagnosis may well have been septic arthritis; the culture rate from synovial fluid in suspected septic arthritis has a wide range with reports of as low as 16% [1]. Another important diagnosis to consider is transient synovitis.…”

Section: Discussionmentioning

confidence: 99%

Acute rheumatic fever: an important differential diagnosis of septic arthritis

Mataika¹,

Carapetis²,

Kado³

et al. 2007

Journal of Tropical Pediatrics

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SummaryWe present three cases of suspected septic arthritis in which the joint fluid was sterile. Subsequently all three patients were diagnosed with established moderate-severe rheumatic heart disease. In retrospect it is likely that the earlier presentations were in fact episodes of acute rheumatic fever but were not recognized as such. These cases underline the importance of acute rheumatic fever as a differential diagnosis of septic arthritis when the joint fluid is sterile, particularly in regions where there are high rates of acute rheumatic fever and rheumatic heart disease.

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Bacterial aetiology of acute osteoarticular infections in children

Abstract: 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.

Cited by 110 publications

References 10 publications

Kingella kingae: Carriage, Transmission, and Disease

Kingella kingae: Carriage, Transmission, and Disease

Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study

Acute rheumatic fever: an important differential diagnosis of septic arthritis

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