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Valisena S, De Marco G, Cochard B, Di Laura Frattura G, Bazin L, Vazquez O, Steiger C, Dayer R, Ceroni D. Is the emergency MRI protocol for acute pediatric osteoarticular infection a luxury or an absolute priority? Front Pediatr 2023; 11:1328870. [PMID: 38155738 PMCID: PMC10753816 DOI: 10.3389/fped.2023.1328870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
- Silvia Valisena
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
| | - Blaise Cochard
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
- Division of Orthopedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Giorgio Di Laura Frattura
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
| | - Ludmilla Bazin
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
| | - Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals, Geneva, Switzerland
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Abstract
PURPOSE OF REVIEW The aim of this article is to review the recent guidelines and literature regarding the diagnosis and the treatment of common pediatric musculoskeletal infections: septic arthritis, osteomyelitis, pyomyositis, and Lyme disease. RECENT FINDINGS In the last decade, a better understanding of the causative organisms of common bacterial infections, including Kingella , leads to prompt targeted antimicrobial coverage in all musculoskeletal infections. Prompt diagnosis and treatment continues to be the mainstay in the treatment of children with osteoarticular infections. Efforts to improve early detection have lead to improving rapid lab diagnostic testing; however, more advanced diagnostics such as arthrocentesis for septic arthritis and MRI for osteomyelitis and pyomyositis, remain the gold standard. Shorter and narrowed antibiotic courses, with appropriate transition to outpatient oral treatment provide effective infection clearance and reduction in complications of disease. SUMMARY Advances in diagnostics, including pathogen identification as well as imaging continues to improve our ability to diagnose and treat these infections, although still lack ability to provide definitive diagnosis without more invasive nor advanced techniques.
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Affiliation(s)
- Megan Hannon
- Division of Emergency Medicine
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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3
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Yagupsky P. The Past, Present, and Future of Kingella kingae Detection in Pediatric Osteoarthritis. Diagnostics (Basel) 2022; 12:diagnostics12122932. [PMID: 36552939 PMCID: PMC9777514 DOI: 10.3390/diagnostics12122932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
As a result of the increasing use of improved detection methods, Kingella kingae, a Gram-negative component of the pediatric oropharyngeal microbiota, is increasingly appreciated as the prime etiology of septic arthritis, osteomyelitis, and spondylodiscitis in children aged 6 to 48 months. The medical literature was reviewed to summarize the laboratory methods required for detecting the organism. Kingella kingae is notoriously fastidious, and seeding skeletal system samples onto solid culture media usually fails to isolate it. Inoculation of synovial fluid aspirates and bone exudates into blood culture vials enhances Kingella kingae recovery by diluting detrimental factors in the specimen. The detection of the species has been further improved by nucleic acid amplification tests, especially by using species-specific primers targeting Kingella kingae's rtxA, groEL, and mdh genes in a real-time PCR platform. Although novel metagenomic next-generation technology performed in the patient's plasma sample (liquid biopsy) has not yet reached its full potential, improvements in the sensitivity and specificity of the method will probably make this approach the primary means of diagnosing Kingella kingae infections in the future.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva 8410500, Israel
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4
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Alcobendas Rueda RM, Núñez E, Martín L, Hernández MB, Saavedra-Lozano J, Udaondo C, Murias S, Remesal A, Calvo C. Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom? Pediatr Infect Dis J 2022; 41:e351-e357. [PMID: 35763692 DOI: 10.1097/inf.0000000000003619] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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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Affiliation(s)
| | - Esmeralda Núñez
- Pediatrics Department, Hospital Materno-Infantil, Málaga, Spain
| | - Laura Martín
- Pediatrics Department, Hospital Materno-Infantil, Málaga, Spain
| | | | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid
| | - Clara Udaondo
- From the, Pediatric Rheumatology Unit, Hospital Universitario La Paz
| | - Sara Murias
- From the, Pediatric Rheumatology Unit, Hospital Universitario La Paz
| | - Agustin Remesal
- From the, Pediatric Rheumatology Unit, Hospital Universitario La Paz
| | - Cristina Calvo
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain
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5
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Ossurarson F, Thors V, Haraldsson A. Simplified antibiotic treatment for paediatric osteoarticular infections achieved good outcomes. Acta Paediatr 2022; 111:2188-2194. [PMID: 35924594 DOI: 10.1111/apa.16510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/23/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
AIM Early diagnosis of osteoarticular infections (OAI) in children and effective treatment prevents complications. The objective of this study was to evaluate effectiveness and safety of shortened intravenous antibiotic treatment of OAI. Incidence, diagnostics, and pathogens of paediatric OAI were assessed. METHODS This retrospective study included all paediatric OAI admissions to The Children's Hospital Iceland in 2006-2020. The treatment was evaluated by dividing the study cohort into two groups. The simplified treatment group received intravenous antibiotics for less than seven days. The longer intravenous group received intravenous antibiotics for a minimum of seven days. RESULTS In total, 205 cases of OAI were included: 106 osteomyelitis, 83 septic arthritis and 16 with both. Age standardized incidence was 17 per 100,000 children and decreased over the study period (p = 0.004). A pathogen was identified in 37% (75/205) of cases of which 65% (49/75) were Staphylococcus aureus and 12% (9/75) Kingella kingae. Simplified treatment was not associated with increased risk of complications. CONCLUSION This study supports claims that simplified treatment for OAI is safe and effective. Further simplification of treatment might be viable. For uncertain reasons the incidence of OAI was decreasing in Iceland, predominantly in young children.
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Affiliation(s)
| | - Valtyr Thors
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland.,Children´s Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | - Asgeir Haraldsson
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland.,Children´s Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
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6
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Kingella kingae Tenosynovitis: No Need for Surgical Management? Pediatr Infect Dis J 2022; 41:e302-e303. [PMID: 35389939 DOI: 10.1097/inf.0000000000003547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Distinguishing Kingella kingae from Pyogenic Acute Septic Arthritis in Young Portuguese Children. Microorganisms 2022; 10:microorganisms10061233. [PMID: 35744752 PMCID: PMC9227297 DOI: 10.3390/microorganisms10061233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: We aim to identify clinical and laboratorial parameters to distinguish Kingella kingae from pyogenic septic arthritis (SA). (2) Methods: A longitudinal, observational, single-centre study of children < 5 years old with microbiological positive SA admitted to a paediatric hospital from 2013−2020 was performed. Clinical and laboratorial data at admission and at 48 h, as well as on treatment and evolution, were obtained. (3) Results: We found a total of 75 children, 44 with K. kingae and 31 with pyogenic infections (mostly MSSA, S. pneumoniae and S. pyogenes). K. kingae affected younger children with low or absent fever, low inflammatory markers and a favourable prognosis. In the univariate analyses, fever, septic look, CRP and ESR at admission and CRP at 48 h were significantly lower in K. kingae SA. In the multivariate analyses, age > 6 months ≤ 2 years, apyrexy and CRP ≤ 100 mg/L were significative, with an overall predictive positive value of 86.5%, and 88.4% for K. kingae. For this model, ROC curves were capable of differentiating (AUC 0.861, 95% CI 0.767−0.955) K. kingae SA from typical pathogens. (4) Conclusions: Age > 6 months ≤ 2 years, apyrexy and PCR ≤ 100 mg/L were the main predictive factors to distinguish K. kingae from pyogenic SA < 5 years. These data need to be validated in a larger study.
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Grant DS, Neville DN, Levas M, Balamuth F, Garro AC, Bennett JE, Thompson AD, Kharbanda AB, Lyons TW, Nigrovic LE. Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area. Pediatr Emerg Care 2022; 38:e881-e885. [PMID: 34160185 DOI: 10.1097/pec.0000000000002455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In Lyme disease endemic areas, Lyme and septic arthritis often present similarly. A published septic knee arthritis clinical prediction rule includes 2 high-risk predictors: absolute neutrophil count of 10,000 cells/mm3 or greater and erythrocyte sedimentation rate of 40 mm/h or greater. The objective of the study was to externally validate this prediction rule in a multicenter prospective cohort. METHODS We enrolled a prospective cohort of children with knee monoarthritis undergoing evaluation for Lyme disease at 1 of 8 Pedi Lyme Net emergency departments located in endemic areas. We defined a case of septic arthritis with a positive synovial fluid culture or a synovial fluid white blood cell count of 50,000 or greater per high powered field with a positive blood culture and Lyme arthritis with a positive or equivocal C6 EIA, followed by a positive supplemental immunoblot. Other children were classified as having inflammatory arthritis. We report the performance of the septic arthritis clinical prediction rule in our study population. RESULTS Of the 543 eligible children, 13 had septic arthritis (2.4%), 234 Lyme arthritis (43.1%), and 296 inflammatory arthritis (54.5%). Of the 457 children (84.2%) with available laboratory predictors, all children with septic arthritis were classified as high risk (sensitivity, 100%; 95% confidence interval [CI], 77.2%-100%; specificity, 68.1%; 95% CI, 63.6-73.3; negative predictive value, 278/278 [100%]; 95% CI, 98.6%-100%). Of the 303 low-risk children, 52 (17.2%) underwent diagnostic arthrocentesis. CONCLUSIONS The septic knee arthritis clinical prediction rule accurately distinguished between septic and Lyme arthritis in an endemic area. Clinical application may reduce unnecessary invasive diagnostic procedures.
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Affiliation(s)
| | - Desiree N Neville
- Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Michael Levas
- Division of Pediatric Emergency Medicine, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Fran Balamuth
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Aris C Garro
- Departments of Pediatrics and Emergency Medicine, Hasbro Children's Hospital, Providence, RI
| | - Jonathan E Bennett
- Division of Emergency Medicine, Nemours/A.I. duPont Hospital for Children, Wilmington, DE
| | - Amy D Thompson
- Division of Emergency Medicine, Nemours/A.I. duPont Hospital for Children, Wilmington, DE
| | | | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
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9
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Searns JB, DeVine MN, MacBrayne CE, Williams MC, Pearce K, Donaldson N, Parker SK. Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections. J Pediatr Orthop 2022; 42:e206-e211. [PMID: 34923507 DOI: 10.1097/bpo.0000000000002033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Identifying the causative pathogen for acute hematogenous musculoskeletal infections (MSKIs) allows for directed antimicrobial therapy and diagnostic confidence. However, 20% to 50% of children with acute MSKIs remain culture negative. The objective of this study was to compare characteristics of culture negative MSKI patients to those where a pathogen is identified. METHODS Electronic medical records of children admitted between July 2014 to September 2018 to a single quaternary care pediatric hospital with acute MSKIs were retrospectively reviewed. Clinical and demographic characteristics were compared between culture positive and culture negative MSKIs. RESULTS A total of 170 patients were included of whom 43 (25%) were culture negative. All culture negative patients had at least 1 culture type obtained, and the majority (84%) had both blood and source cultures performed. When compared with patients with a causative pathogen identified, culture negative patients were younger (2.3 vs. 9.8 y), smaller (13.5 vs. 31.6 kg), less likely to be febrile on arrival (56% vs. 77%), less likely to have an abscess on imaging (23% vs. 48%), and were more likely to have uncomplicated septic arthritis (35% vs. 8%). No critically ill patient was culture negative. Seven culture negative patients had additional Kingella kingae testing performed, none of which were positive. CONCLUSIONS Despite targeted and standardized efforts to identify causative bacteria, 25% of children with acute MSKIs never have a pathogen identified. Culture negative patients are younger, less febrile, are less likely to have an abscess, and more likely to have isolated septic arthritis. LEVEL OF EVIDENCE This is a retrospective cohort study interested in identifying patient characteristics that predict rate of culture positivity for acute MSKIs. This study meets criteria for Level II evidence.
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Affiliation(s)
- Justin B Searns
- Department of Pediatrics, Sections of Hospital Medicine and Infectious Diseases
| | | | | | | | - Kelly Pearce
- Infection Prevention and Control, Children's Hospital Colorado, Aurora, CO
| | | | - Sarah K Parker
- Department of Pediatrics, Section of Infectious Diseases
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10
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Gouveia C, Branco J, Norte S, Arcangelo J, Alves P, Pinto M, Tavares D. Acute haematogenous osteomyelitis in Lisbon: an unexpectedly high association with myositis and arthritis. An Pediatr (Barc) 2022; 96:106-114. [DOI: 10.1016/j.anpede.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
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Yagupsky P. Changing aetiology of paediatric septic arthritis. J Paediatr Child Health 2021; 57:1560-1563. [PMID: 34259365 DOI: 10.1111/jpc.15654] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Serrera A, Rodríguez-Cuitiño L, Cabañas F. Occult bacteremia due to Kingella kingae associated with herpetic gingivostomatitis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:360-361. [PMID: 34353518 DOI: 10.1016/j.eimce.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/11/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Alicia Serrera
- Departamento de Análisis Clínicos, Hospital Universitario Quironsalud Madrid, Madrid, Spain.
| | - Lucia Rodríguez-Cuitiño
- Departamento de Pediatría y Neonatolología, Hospital Universitario Quironsalud Madrid, Madrid, Spain
| | - Fernando Cabañas
- Departamento de Pediatría y Neonatolología, Hospital Universitario Quironsalud Madrid, Madrid, Spain
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13
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Gouveia C, Duarte M, Norte S, Arcangelo J, Pinto M, Correia C, Simões MJ, Canhão H, Tavares D. Kingella kingae Displaced S. aureus as the Most Common Cause of Acute Septic Arthritis in Children of All Ages. Pediatr Infect Dis J 2021; 40:623-627. [PMID: 33657599 DOI: 10.1097/inf.0000000000003105] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute septic arthritis (SA) still remains a challenge with significant worldwide morbidity. In recent years, Kingella kingae has emerged and treatment regimens have become shorter. We aim to analyze trends in SA etiology and management and to identify risk factors for complications. METHODS Longitudinal observational, single center study of children (<18 years old) with SA admitted to a tertiary care pediatric hospital, from 2003 to 2018, in 2 cohorts, before and after implementation of nucleic acid amplification assays (2014). Clinical, treatment and disease progression data were obtained. RESULTS A total of 247 children were identified, with an average annual incidence of 24.9/100,000, 57.9% males with a median age of 2 (1-6) years. In the last 5 years, a 1.7-fold increase in the annual incidence, a lower median age at diagnosis and an improved microbiologic yield (49%) was noticed. K. kingae became the most frequent bacteria (51.9%) followed by MSSA (19.2%) and S. pyogenes (9.6%). Children were more often treated for fewer intravenous days (10.7 vs. 13.2 days, P = 0.01) but had more complications (20.6% vs. 11.4%, P = 0.049) with a similar sequelae rate (3.7%). Risk factors for complications were C-reactive protein ≥80 mg/L and Staphylococcus aureus infection, and for sequelae at 6 months, age ≥4 years and CRP ≥ 80 mg/L. CONCLUSIONS The present study confirms that K. kingae was the most common causative organism of acute SA. There was a trend, although small, for decreasing antibiotic duration. Older children with high inflammatory parameters might be at higher risk of sequelae.
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Affiliation(s)
- Catarina Gouveia
- From the Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC-EPE, Lisbon, Portugal
- Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Mariana Duarte
- From the Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Susana Norte
- Pediatric Orthopedic Unit, Hospital de Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Joana Arcangelo
- Pediatric Orthopedic Unit, Hospital de Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Margarida Pinto
- Patologia Clinica, Hospital de Dona Estefânia, CHULC-EPE, Lisbon, Portugal
| | - Cristina Correia
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal
| | - Maria João Simões
- Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal
| | - Helena Canhão
- Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Delfin Tavares
- Pediatric Orthopedic Unit, Hospital de Dona Estefânia, CHULC-EPE, Lisbon, Portugal
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Coulin B, Demarco G, Spyropoulou V, Juchler C, Vendeuvre T, Habre C, Tabard-Fougère A, Dayer R, Steiger C, Ceroni D. Osteoarticular infection in children. Bone Joint J 2021; 103-B:578-583. [PMID: 33641416 DOI: 10.1302/0301-620x.103b3.bjj-2020-0936.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae. METHODS The medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed. RESULTS K. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot. CONCLUSION K. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578-583.
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Affiliation(s)
- Benoit Coulin
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Giacomo Demarco
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Vanessa Spyropoulou
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Celine Juchler
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Tanguy Vendeuvre
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Céline Habre
- Pediatric Radiology Unit, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Romain Dayer
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Service, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
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Gouveia C, Branco J, Norte S, Arcangelo J, Alves P, Pinto M, Tavares D. [Acute haematogenous osteomyelitis in Lisbon: An unexpectedly high association with myositis and arthritis]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00001-1. [PMID: 33674248 DOI: 10.1016/j.anpedi.2020.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/31/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Despite the current trend towards less aggressive therapeutic approaches, acute haematogenous osteomyelitis (AHO) continues to be a challenge and is associated with significant morbidity worldwide. Our aim was to determine if 80% compliance with current protocol was achieved, identify complications and associated risk factors and analyse trends in aetiology and management of AHO in children. METHODS We conducted a longitudinal, observational, single-centre study in patients with AHO aged less than 18 years admitted to a paediatric hospital, between 2008 and 2018, divided into 2 cohorts (before and after 2014). Demographic, clinical data and disease progression were analysed. RESULTS The study included 71 children with AHO, 56% male, with a median age of 3 years (interquartile range, 1-11). We found a 1.8-fold increase of cases in the last 5 years. The causative agent was identified in 37% of cases: MSSA (54%), MRSA (4%), Streptococcus pyogenes (19%), Kingella kingae (12%), Streptococcus pneumoniae (8%), and Neisseria meningitidis (4%). Complications were identified in 45% of patients and sequelae in 3.6%. In recent years, there was an increase in myositis (30% vs. 7%; p=0.02), septic arthritis (68% vs. 37.2%; p=0.012) and in the proportion of patients treated for less than 4 weeks (37% vs. 3.5%; p=0.012), with a similar sequelae rates. The risk factors for complications were age 3 or more years, CRP levels of 20mg/l or higher, time elapsed between onset and admission of 5 or more days and positive culture, although on multivariate analysis only positive culture was significant. The presence of complications was a risk factor for sequelae at 6 months. CONCLUSIONS Our study confirms that AHO can be aggressive. The identification of risk factors for complications may be fundamental for management.
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Affiliation(s)
- Catarina Gouveia
- Unidad de Enfermedades Infecciosas, Hospital de Dona Estefânia, CHULC - EPE, Lisboa, Portugal; Nova Medical School, Faculdade de Ciências Médicas, Lisboa, Portugal.
| | - Joana Branco
- Unidad de Enfermedades Infecciosas, Hospital de Dona Estefânia, CHULC - EPE, Lisboa, Portugal
| | - Susana Norte
- Unidad de Ortopedia Pediátrica, Hospital de Dona Estefânia, CHULC - EPE, Lisboa, Portugal
| | - Joana Arcangelo
- Unidad de Ortopedia Pediátrica, Hospital de Dona Estefânia, CHULC - EPE, Lisboa, Portugal
| | - Pedro Alves
- Diagnóstico Radiológico, Centro Tecnológico e Biomédico, Hospital de Dona Estefânia, CHULC - EPE, Lisboa, Portugal
| | - Margarida Pinto
- Patología Clínica, Hospital de Dona Estefânia, CHULC - EPE, Lisboa, Portugal
| | - Delfin Tavares
- Unidad de Ortopedia Pediátrica, Hospital de Dona Estefânia, CHULC - EPE, Lisboa, Portugal
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Oropharyngeal Carriage of Kingella kingae and Transient Synovitis of the Hip in Young Children: A Case-control Study. Pediatr Infect Dis J 2021; 40:182-185. [PMID: 33427802 DOI: 10.1097/inf.0000000000002944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transient synovitis of the hip affects mostly preschool children, and its etiology is unknown. Kingella kingae has been identified recently as a common etiologic agent of osteoarticular infections (OAI) in young children and could potentially be associated to transient synovitis of the hip. The main objective of this study was to evaluate the association between transient synovitis of the hip and oropharyngeal carriage of K. kingae among preschool children. METHODS This was a prospective case-control study conducted at a tertiary care pediatric emergency department. Cases were children between 6 and 71 months of ages with a diagnosis of transient synovitis of the hip. For each transient synovitis case, an age-matched control was recruited among children presenting for a trauma. A second control group included children with any OAI. The independent variable was the presence of oropharyngeal K. kingae identified by a specific polymerase chain reaction assay. The primary analysis was the association between oropharyngeal K. kingae carriage and final diagnosis. RESULTS A total of 73 children were included in the study. Among them, 25 had a transient synovitis, 16 an OAI, and 22 controls. Baseline demographics were similar between the groups. There was no difference in oropharyngeal carriage of K. kingae for children with transient synovitis (5/25; 0.20) in comparison to controls (3/22; 0.14), while it was higher for children with OAI (10/16; 0.63). CONCLUSIONS There is no association between oropharyngeal K. kingae and transient synovitis of the hip among preschool children.
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18
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Thomas M, Bonacorsi S, Simon AL, Mallet C, Lorrot M, Faye A, Dingulu G, Caseris M, Boneca IG, Aupiais C, Meinzer U. Acute monoarthritis in young children: comparing the characteristics of patients with juvenile idiopathic arthritis versus septic and undifferentiated arthritis. Sci Rep 2021; 11:3422. [PMID: 33564018 PMCID: PMC7873238 DOI: 10.1038/s41598-021-82553-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
Acute arthritis is a common cause of consultation in pediatric emergency wards. Arthritis can be caused by juvenile idiopathic arthritis (JIA), septic (SA) or remain undetermined (UA). In young children, SA is mainly caused by Kingella kingae (KK), a hard to grow bacteria leading generally to a mild clinical and biological form of SA. An early accurate diagnosis between KK-SA and early-onset JIA is essential to provide appropriate treatment and follow-up. The aim of this work was to compare clinical and biological characteristics, length of hospital stays, duration of intravenous (IV) antibiotics exposure and use of invasive surgical management of patients under 6 years of age hospitalized for acute monoarthritis with a final diagnosis of JIA, SA or UA. We retrospectively analyzed data from < 6-year-old children, hospitalized at a French tertiary center for acute mono-arthritis, who underwent a joint aspiration. Non-parametric tests were performed to compare children with JIA, SA or UA. Bonferroni correction for multiple comparisons was applied with threshold for significance at 0.025. Among the 196 included patients, 110 (56.1%) had SA, 20 (10.2%) had JIA and 66 (33.7%) had UA. Patients with JIA were older when compared to SA (2.7 years [1.8–3.6] versus 1.4 [1.1–2.1], p < 0.001). Presence of fever was not different between JIA and SA or UA. White blood cells in serum were lower in JIA (11.2 × 109/L [10–13.6]) when compared to SA (13.2 × 109/L [11–16.6]), p = 0.01. In synovial fluid leucocytes were higher in SA 105.5 × 103 cells/mm3 [46–211] compared to JIA and UA (42 × 103 cells/mm3 [6.4–59.2] and 7.29 × 103 cells/mm3 [2.1–72] respectively), p < 0.001. Intravenous antibiotics were administered to 95% of children with JIA, 100% of patients with SA, and 95.4% of UA. Arthrotomy-lavage was performed in 66.7% of patients with JIA, 79.6% of patients with SA, and 71.1% of patients with UA. In children less than 6 years of age with acute mono-arthritis, the clinical and biological parameters currently used do not reliably differentiate between JIA, AS and UA. JIA subgroups that present a diagnostic problem at the onset of monoarthritis before the age of 6 years, are oligoarticular JIA and systemic JIA with hip arthritis. The development of new biomarkers will be required to distinguish JIA and AS caused by Kingellakingae in these patients.
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Affiliation(s)
- Marion Thomas
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France.,Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France.,CNRS UMR2001, Paris, France.,INSERM, Equipe Avenir, Paris, France
| | - Stephane Bonacorsi
- Université de Paris, Paris, France.,Department of Microbiology, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne-Laure Simon
- Université de Paris, Paris, France.,Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cindy Mallet
- Université de Paris, Paris, France.,Pediatric Orthopedic Department, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathie Lorrot
- Pediatric Department, Division of Infectious Diseases, Armand Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France.,Université de Paris, Paris, France
| | - Glory Dingulu
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France
| | - Ivo Gomperts Boneca
- Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France.,CNRS UMR2001, Paris, France.,INSERM, Equipe Avenir, Paris, France
| | - Camille Aupiais
- Pediatric Emergency Department, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Bondy, France.,INSERM, U1138, Equipe 22, Centre de Recherche des Cordeliers, Paris, France
| | - Ulrich Meinzer
- Department of General Pediatrics, Pediatric Internal Medicine, Rheumatology and Infectious Diseases, National Reference Centre for Rare Pediatric Inflammatory Rheumatisms and Systemic Autoimmune Diseases RAISE, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, 75019, Paris, France. .,Institut Pasteur, Biology and Genetics of Bacterial Cell Wall Unit, Paris, France. .,CNRS UMR2001, Paris, France. .,INSERM, Equipe Avenir, Paris, France. .,Université de Paris, Paris, France. .,Centre de Recherche sur l'inflammation, UMR1149 INSERM et Université de Paris, Paris, France.
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Serrera A, Rodríguez-Cuitiño L, Cabañas F. Occult bacteremia due to Kingella kingae associated with herpetic gingivostomatitis. Enferm Infecc Microbiol Clin 2020. [PMID: 33143858 DOI: 10.1016/j.eimc.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alicia Serrera
- Departamento de Análisis Clínicos, Hospital Universitario Quironsalud Madrid, Madrid, España.
| | - Lucía Rodríguez-Cuitiño
- Departamento de Pediatría y Neonatolología, Hospital Universitario Quironsalud Madrid, Madrid, España
| | - Fernando Cabañas
- Departamento de Pediatría y Neonatolología, Hospital Universitario Quironsalud Madrid, Madrid, España
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Autore G, Bernardi L, Esposito S. Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy. Antibiotics (Basel) 2020; 9:antibiotics9080486. [PMID: 32781552 PMCID: PMC7459809 DOI: 10.3390/antibiotics9080486] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 01/01/2023] Open
Abstract
Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.
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Predicting the causative pathogen among children with osteomyelitis using Bayesian networks - improving antibiotic selection in clinical practice. Artif Intell Med 2020; 107:101895. [PMID: 32828444 DOI: 10.1016/j.artmed.2020.101895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 05/19/2020] [Accepted: 05/29/2020] [Indexed: 11/21/2022]
Abstract
Infection of bone, osteomyelitis (OM), is a serious bacterial infection in children requiring urgent antibiotic therapy. While biological specimens are often obtained and cultured to guide antibiotic selection, culture results may take several days, are often falsely negative, and may be falsely positive because of contamination by non-causative bacteria. This poses a dilemma for clinicians when choosing the most suitable antibiotic. Selecting an antibiotic which is too narrow in spectrum risks treatment failure; selecting an antibiotic which is too broad risks toxicity and promotes antibiotic resistance. We have developed a Bayesian Network (BN) model that can be used to guide individually targeted antibiotic therapy at point-of-care, by predicting the most likely causative pathogen in children with OM and the antibiotic with optimal expected utility. The BN explicitly models the complex relationship between the unobserved infecting pathogen, observed culture results, and clinical and demographic variables, and integrates data with critical expert knowledge under a causal inference framework. Development of this tool resulted from a multidisciplinary approach, involving experts in infectious diseases, modelling, paediatrics, microbiology, computer science and statistics. The model-predicted prevalence of causative pathogens among children with osteomyelitis were 56 % for Staphylococcus aureus, 17 % for 'other' culturable bacteria (like Streptococcus pyogenes), and 27 % for bacterial pathogens that are not culturable using routine methods (like Kingella kingae). Log loss cross-validation suggests that the model performance is robust, with the best fit to culture results achieved when data and expert knowledge were combined during parameterisation. AUC values of 0.68 - 0.77 were achieved for predicting culture results of different types of specimens. BN-recommended antibiotics were rated optimal or adequate by experts in 82-98% of 81 cases sampled from the cohort. We have demonstrated the potential use of BNs in improving antibiotic selection for children with OM, which we believe to be generalisable in the development of a broader range of decision support tools. With appropriate validation, such tools might be effectively deployed for real-time clinical decision support, to promote a shift in clinical practice from generic to individually-targeted antibiotic therapy, and ultimately improve the management and outcomes for a range of serious bacterial infections.
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22
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Wong M, Williams N, Cooper C. Systematic Review of Kingella kingae Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:73-84. [PMID: 32158303 PMCID: PMC7048951 DOI: 10.2147/phmt.s217475] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/07/2019] [Indexed: 12/19/2022]
Abstract
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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Affiliation(s)
- Maria Wong
- Department of Orthopaedic Surgery, Women and Children's Hospital, Adelaide, SA, Australia
| | - Nicole Williams
- Department of Orthopaedic Surgery, Women and Children's Hospital, Adelaide, SA, Australia.,Center for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, Australia
| | - Celia Cooper
- Department of Infectious Diseases, Women and Children's Hospital, Adelaide, SA, Australia
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Pediatric Infectious Prepatellar Bursitis with Kingella kingae. Case Rep Orthop 2020; 2020:6586517. [PMID: 32047688 PMCID: PMC7007931 DOI: 10.1155/2020/6586517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/18/2020] [Indexed: 12/02/2022] Open
Abstract
We present the first reported case of septic prepatellar bursitis with Kingella kingae in a 2-year-old female. Although it is a well-established cause of osteoarticular infections in the pediatric population, K. kingae has never been reported as the etiology for septic bursitis. A high index of suspicion is required for the diagnosis given that this organism is difficult to culture and isolate using standard laboratory methods. Our diagnosis was established through bursal fluid analysis, though oropharyngeal polymerase chain reaction (PCR) may be also be considered. Our case also builds upon prior literature suggesting that the pathophysiology of septic bursitis in children differs from that of the adult and may be more comparable to that of pediatric osteomyelitis. As an organism of increasing prevalence, K. kingae should remain high on the differential for osteoarticular or periarticular infections when cultures fail to isolate a distinct pathogen. Early diagnosis and a formal irrigation and debridement, if warranted, are crucial in preventing devastating complications of untreated septic bursitis.
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24
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Asymptomatic Pharyngeal Carriage of Kingella kingae Among Young Children in Vancouver, British Columbia, Canada. Pediatr Infect Dis J 2019; 38:990-993. [PMID: 31335573 DOI: 10.1097/inf.0000000000002403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kingella kingae has emerged as a significant cause of osteoarticular infections in young children. Pharyngeal colonization is considered a prerequisite for invasive K. kingae infection. We conducted a prospective study to estimate the prevalence of pharyngeal carriage of K. kingae among healthy young children in Vancouver. METHODS From March 2016 to May 2017, children between 6 and 48 months of age visiting British Columbia Children's Hospital outpatient clinics for noninfectious causes were included in the study. Another set of participants was enrolled from a day-care center located at British Columbia Children's Hospital. A single-throat swab was collected after obtaining consent from parent/guardian. The samples were stored at -70°C and tested using an in-house developed real-time polymerase chain reaction assay. Epidemiologic characteristics and risk factors for K. kingae colonization were collected via a study questionnaire. RESULTS A total of 179 children were enrolled in the study, but only 174 samples were eligible for testing. Of the 174 samples, 5 had indeterminate results and the remaining 169 samples were negative by K. kingae polymerase chain reaction. The median age of participants was 23 months. About 36% of children were attending day care and had another sibling <5 years of age. Previous history of cold symptoms and antibiotic use was reported in 42% and 12%, respectively. CONCLUSIONS The results of our study showed no prevalence of asymptomatic pharyngeal carriage of K. kingae in young children in Vancouver. Additional multicenter studies may help to understand the differences in pharyngeal carriage rate among healthy children.
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Ceroni D, Dayer R, Steiger C. Are we approaching the end of pediatric culture-negative osteoarticular infections? Future Microbiol 2019; 14:917-919. [DOI: 10.2217/fmb-2019-0141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Dimitri Ceroni
- Service of Orthopedics, Department of Child & Adolescent, University of Geneva Hospitals & University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Romain Dayer
- Service of Orthopedics, Department of Child & Adolescent, University of Geneva Hospitals & University of Geneva Faculty of Medicine, Geneva, Switzerland
| | - Christina Steiger
- Service of Orthopedics, Department of Child & Adolescent, University of Geneva Hospitals & University of Geneva Faculty of Medicine, Geneva, Switzerland
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Hérissé AL, Luci AL, Solla F, Guesmi M, Demonchy D, Rampal V, Haas H, Tran A. Rare cause of cervical osteoarthritis. Arch Dis Child 2019; 104:558. [PMID: 30177557 DOI: 10.1136/archdischild-2018-315266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Anne-Laure Hérissé
- Pediatric Emergency Department, Hôpitaux Pédiatriques CHU Lenval, Nice, France
| | - Anne-Lise Luci
- Pediatric Emergency Department, Hôpitaux Pédiatriques CHU Lenval, Nice, France
| | - Federico Solla
- Pediatric Orthopedic Surgery, Hôpitaux Pédiatriques CHU Lenval, Nice, France
| | - Myriam Guesmi
- Department of Pediatric Radiology, Hôpitaux Pédiatriques CHU Lenval, Nice, France
| | - Diane Demonchy
- Pediatric Emergency Department, Hôpitaux Pédiatriques CHU Lenval, Nice, France
| | - Virginie Rampal
- Pediatric Orthopedic Surgery, Hôpitaux Pédiatriques CHU Lenval, Nice, France
| | - Hervé Haas
- Pediatric Emergency Department, Hôpitaux Pédiatriques CHU Lenval, Nice, France
| | - Antoine Tran
- Pediatric Emergency Department, Hôpitaux Pédiatriques CHU Lenval, Nice, France
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27
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Kingella-kingae-Infektionen im Kindesalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-018-0471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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29
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O'Rourke S, Meehan M, Bennett D, O'Sullivan N, Cunney R, Gavin P, McNamara R, Cassidy N, Ryan S, Harris K, Drew R. The role of real-time PCR testing in the investigation of paediatric patients with community-onset osteomyelitis and septic arthritis. Ir J Med Sci 2019; 188:1289-1295. [PMID: 30706296 DOI: 10.1007/s11845-019-01973-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/19/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Culture yield in osteomyelitis and septic arthritis is low, emphasising the role for molecular techniques. AIMS The purpose of this study was to review the laboratory investigation of childhood osteomyelitis and septic arthritis. METHODS A retrospective review was undertaken in an acute tertiary referral paediatric hospital from January 2010 to December 2016. Cases were only included if they had a positive culture or bacterial PCR result from a bone/joint specimen or blood culture, or had radiographic evidence of osteomyelitis. RESULTS Seventy-eight patients met the case definition; 52 (66%) were male. The median age was 4.8 years. Blood cultures were positive in 16 of 56 cases (29%), with 11 deemed clinically significant (Staphylococcus aureus = 8, group A Streptococcus = 3). Thirty-seven of 78 (47%) bone/joint samples were positive by culture with S. aureus (n = 16), coagulase-negative Staphylococcus (n = 9) and group A Streptococcus (n = 4), being the most common organisms. Sixteen culture-negative samples were sent for bacterial PCR, and four were positive (Kingella kingae = 2, Streptococcus pneumoniae = 1, group A Streptococcus = 1). CONCLUSIONS Sequential culture and PCR testing can improve the detection rate of causative organisms in paediatric bone and joint infections, particularly for fastidious microorganisms such as K. kingae. PCR testing can be reserved for cases where culture is negative after 48 h. These results have been used to develop a standardised diagnostic test panel for bone and joint infections at our institution.
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Affiliation(s)
- Sadhbh O'Rourke
- Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland.
| | - Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Désirée Bennett
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Nicola O'Sullivan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Robert Cunney
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland.,Health Protection Surveillance Centre, Dublin 1, Ireland
| | - Patrick Gavin
- Department of Infectious Diseases, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Roisin McNamara
- Emergency Department, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Noelle Cassidy
- Department of Orthopaedics, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Stephanie Ryan
- Department of Radiology, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Kathryn Harris
- Department of Microbiology, Virology and Infection Prevention and Control, Great Ormond Street NHS Foundation Trust, London, UK
| | - Richard Drew
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin 1, Ireland.,Department of Clinical Microbiology, Royal College of Surgeons, Dublin 2, Ireland.,Clinical Innovation Unit, Rotunda Hospital, Dublin 1, Ireland
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Illán-Ramos M, Guillén-Martín S, Prieto-Tato LM, Cacho-Calvo JB, González-Romo F, Francisco-González L, Ramos-Amador JT. [Kingella kingae as a common cause of arthritis septic in children]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2018; 31:439-442. [PMID: 30251525 PMCID: PMC6194870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Kingella kingae is a common colonizer of the oropharynx in children that may lead to invasive infection, mainly osteoarticular infections. Invasive infections occur almost exclusively in young children, fundamentally fewer than two years old. K. kingae infections in children are probably underdiagnosed due to the difficulty in growing in routine cultures and the absence of systematic realization of molecular techniques to identify it. It is the most common bacteria involved in childhood osteoarticular infections in recent series and increasingly being recognized in Spain. We report our experience on the epidemiological and clinical characteristics of osteoarticular infections in children in recent years. METHODS Retrospective analysis of septic arthritis by K. kingae identified by PCR in joint fluid in children during 2010-2016. Epidemiological, clinical and laboratory characteristics are presented. RESULTS Five arthritis by K. kingae were identified, all of them in ≤6 years old children. Median leukocytes, CRP and ESR were 12950 leukocytes/μL, 4.84 mg/dL and 58 mm/h respectively, and 61,322 leukocytes /μL in joint fluid. All patients evolved favorably. CONCLUSIONS Osteoarticular infections by K. kingae in children usually present low increase of inflammatory markers despite being invasive infections. The development of PCR in sterile samples has greatly improved the diagnostic yield of K. kingae infections improving the management of osteoarthritis in children.
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Affiliation(s)
- Alex McLaren
- College of Medicine-Phoenix, University of Arizona, Phoenix, Arizona
| | | | - Antonia F Chen
- Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sandra B Nelson
- Harvard Medical School, Boston, Massachusetts.,Massachusetts General Hospital, Boston, Massachusetts
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Valaikaite R, El Houmami N, Spyropoulou V, Braendle G, Ceroni D. Kingella kingae: from oropharyngeal carriage to paediatric osteoarticular infections. Expert Rev Anti Infect Ther 2018; 16:85-87. [PMID: 29291633 DOI: 10.1080/14787210.2018.1421944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Raimonda Valaikaite
- a Paediatric Orthopedic Service , Geneva University Hospitals , Geneva , Switzerland
| | - Nawal El Houmami
- c Aix-Marseille University , Research Unit on Infectious and Emerging Tropical Diseases (URMITE), Institut Hospitalo-Universitaire Méditerranée Infection, Assistance Publique-Hôpitaux de Marseille , Marseille , France
| | | | - Gabriel Braendle
- b Paediatric Service , Geneva University Hospitals , Geneva , Switzerland
| | - Dimitri Ceroni
- a Paediatric Orthopedic Service , Geneva University Hospitals , Geneva , Switzerland
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Affiliation(s)
- Romain Basmaci
- Service de Pédiatrie-Urgences (Basmaci), Hôpital Louis-Mourier, Colombes, France; IAME (Basmaci, Bonacorsi), Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Microbiologie (Bonacorsi), Hôpital Robert-Debré, Centre National de Référence associé Escherichia coli, Paris, France
| | - Stéphane Bonacorsi
- Service de Pédiatrie-Urgences (Basmaci), Hôpital Louis-Mourier, Colombes, France; IAME (Basmaci, Bonacorsi), Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Microbiologie (Bonacorsi), Hôpital Robert-Debré, Centre National de Référence associé Escherichia coli, Paris, France
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