<i>Kingella kingae</i> septic arthritis

Khattak, Mohammed; Chakkalakumbil, Sujith Vellathussery; Stevenson, Robert Allen; Bryson, D.J.; Reidy, Michael; Talbot, Christopher; George, Harvey

doi:10.1302/0301-620x.103b3.bjj-2020-0800.r1

Cited by 8 publications

(3 citation statements)

References 19 publications

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“…22 The ESR/CRP ratio appears as a promising tool in patients with OAI caused by K. kingae. 34 In our study, the median ESR/CRP ratio was higher in group 2 and reached statistical significance in distinguishing K. kingae from the rest of pathogens. When comparing patients with SA, OM, OM-SA from group 1 and 2, those whose causative agent was K. kingae versus the rest of the patients (including those with sterile culture), we identified that an ESR/CRP ratio <0.67 made it possible to rule out, with 91% sensitivity, the presence of K. kingae.…”

Section: Discussionsupporting

confidence: 56%

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Rueda

Núñez

Martin

et al. 2022

Pediatric Infectious Disease Journal

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Background: Osteoarticular infections (OAIs) are typically treated initially with intravenous antibiotics. The objective of this study was to evaluate whether an exclusive oral treatment in selected children may be appropriate. Methods: The Spanish Network of Osteoarticular Infections is a nationwide multicenter registry comprising 37 hospitals in Spain. The registry prospectively includes clinical characteristics and outcome of children with OAI. One of the hospitals from RioPed offers oral treatment to children meeting certain criteria. Patients were classified into 2 groups. Group 1: management with initial intravenous antibiotic therapy. Group 2: patients exclusively treated with oral antibiotics. A comparison between the 2 groups was performed. Results: We compared 893 children who initially received intravenous antibiotics (group 1) with 64 children who received exclusively oral therapy (group 2). Patients from group 2 were younger (33.9 vs. 20.3 months; P = 0.001), had a lower percentage of Staphylococcus aureus (23.3% vs. 3.1%; P < 0.001), a higher proportion of Kingella kingae (12.1% vs. 28.1%; P = 0.001), higher erythrocyte sedimentation rate/C-reactive protein (CRP) ratio (1.4 interquartile range 0.6–3.6 vs. 3.3 interquartile range 1.7–5.7; P < 0.001) and showed lower rate of fever (63% vs. 48.8%; P = 0.024) than in group 1. Complications were not found in group 2. Conclusions: An exclusively oral administration could be a safe option in selected patients with OAI. Low-risk criteria are proposed: good general condition, no underlying disease, 6 months to 3 years old, appropriate oral tolerance, C-reactive protein <80 mg/L, erythrocyte sedimentation rate/C-reactive protein ratio ≥0.67, no skin injury, no recent surgery, no cervical spondylodiscitis and no local complications at onset.

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Section: Discussionsupporting

confidence: 56%

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Rueda

Núñez

Martin

et al. 2022

Pediatric Infectious Disease Journal

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“…However, culture-negative septic arthritis has been reported in up to two-thirds of the cases [28]. K. kingae has been reported to be the most commonly isolated organism from PCR-positive confirmed septic arthritis [29]. Routine cultures performed at most facilities could detect only one-third of these cases.…”

Section: Table 4: Variations In Late Presenting Septic Arthritis Of T...mentioning

confidence: 99%

Late-Presenting Septic Arthritis of the Hip in Children: Variations in Presentation and a Review of 25 Hips After Surgical Debridement

Chand,

Srivastava,

Afaque

et al. 2023

Cureus

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Introduction:The septic arthritis of the hip (SAH) is one of the most common musculoskeletal infections occurring in pediatric populations requiring urgent intervention. This study discusses the myriad of clinical and radiological presentations of late-presenting SAH in children and the outcomes of surgical management.Methods: After ethical approval, we did retrospective reviews of children treated for late-presenting SAH (after five days of symptoms). We excluded late cases with established sequelae. We recorded age, duration of symptoms, clinical evaluation, and radiographs. We evaluated the final results clinically and radiologically.Results: Twenty-four patients with 25 hips were eligible for evaluation. At presentation, all had decreased or painful hip movements, but none had a fever. Radiographs revealed the following changes: hip dislocation (four), capital femoral slip (seven), proximal femur/neck osteomyelitis (six), pathological fractured neck femur (two), iliac osteomyelitis (two), and early arthritic changes (two). Hip arthrotomy was done in all cases. Frank pus was found in 21 (84%) cases. Cases with capital slip and fractured neck femur required fixation with two smooth K-wires. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in three patients and tuberculosis in two cases. Clinical outcomes showed 14 patients with poor outcomes, eight with fair, and two with good. Avascular necrosis (AVN) of the femoral head was noted in 14 hips and complete femoral head resorption in nine.Conclusions: The late-presenting SAH in children has a myriad of presentations including dislocation and capital slip with unsatisfactory outcome. However, ongoing local infective processes may necessitate debridement. With limited salvage options available at the sequelae stage, awareness and training for early diagnosis and treatment may be the best way to improve the scenario. We recommend future multicenter randomized studies of predictive factors and indications of arthrotomy in late presenters.

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“…It reported that the bacterium was detected in 76% of children younger than 48 months with arthritis and 53% of those with osteomyelitis. 21 The leading role of K. kingae as a skeletal system pathogen of early childhood has been demonstrated in Western countries such as the USA 30,31 ; Canada 32 ; Western European countries (Portugal, 33 Spain, 34 France, [19][20][21]25 the UK, 35 and Switzerland 18,22,23,[36][37][38] ); Australia 39 and Israel. 40 These observations do not imply that K. kingae infections are restricted to the industrialised world.…”

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confidence: 99%

Changing aetiology of paediatric septic arthritis

Yagupsky

2021

J Paediatrics Child Health

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The management of septic arthritis in children requires the prompt administration of antibiotic therapy and the identification of the causative pathogen. In the past, Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae and Haemophilus influenzae type b were considered the main causative agents of the disease, but a substantial fraction of presumptive joint infections remained unconfirmed by conventional bacteriologic cultures. In the last two decades, our knowledge of the aetiology of paediatric infectious arthritis has substantially changed as the result of the implementation of vaccination programmes against H. influenzae type b and pneumococci, and by the use of improved detection methods. In 1988, the inoculation of synovial fluid aspirates into blood culture vials revealed that Kingella kingae, a commensal member of the oropharyngeal microbiota, was the prime aetiology of skeletal system infections in children aged 6–48 months. The clinical presentation of K. kingae arthritis is subtle, and the disease is frequently missed by classic clinical and laboratory diagnostic criteria. Many children are afebrile, the acute phase reactants levels and the white blood cell counts in the blood and synovial fluid specimens are frequently normal, requiring a high clinical acumen. Increasing use of sensitive molecular methods in recent years, and particularly nucleic acid amplification tests that target K. kingae‐specific genes, has further improved the detection of this elusive pathogen, demonstrated that it is responsible for 30–93% of all cases of septic arthritis below 4 years of age and reduced the fraction of culture‐negative infections.

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Kingella kingae septic arthritis

Cited by 8 publications

References 19 publications

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Late-Presenting Septic Arthritis of the Hip in Children: Variations in Presentation and a Review of 25 Hips After Surgical Debridement

Changing aetiology of paediatric septic arthritis

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