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Published on: October 20, 2013
Kingella kingae as the Main Cause of Septic Arthritis: Importance of Molecular Diagnosis
María Belén Hernández-Rupérez1, María Del Carmen Suárez-Arrabal1, Ángel Villa-García2
1From the Pediatric Infectious Diseases Unit.
Insights
Kingella kingae is a common cause of pediatric septic arthritis (SA) after implementing 16S rRNA gene sequencing. This molecular technique aids in diagnosing K. kingae, which is associated with milder SA cases and better outcomes in children.
Area of Science:
- Pediatric Infectious Diseases
- Molecular Diagnostics
- Bacteriology
Background:
- Kingella kingae is an emerging pathogen responsible for pediatric septic arthritis (SA).
- Assessing the etiological landscape of pediatric SA before and after adopting universal 16S rRNA gene polymerase chain reaction and sequencing (16SPCR) is crucial.
Purpose of the Study:
- To analyze the changes in the etiology of pediatric septic arthritis (SA) following the implementation of universal 16S rRNA gene polymerase chain reaction and sequencing (16SPCR).
- To compare the clinical characteristics, treatment, and outcomes of SA caused by Kingella kingae versus other bacteria.
Main Methods:
- A retrospective review of children (≤14 years) diagnosed with acute SA in Madrid from 2002-2013.
- Analysis of etiological differences between two periods: before (2002-2008) and after (2009-2013) the implementation of 16SPCR in synovial fluid.
- Comparative analysis of epidemiology, clinical presentation, therapy, and outcomes for K. kingae versus other bacterial etiologies.
Main Results:
- Bacterial detection rates in SA increased significantly after 16SPCR implementation (63% vs. 31.4%).
- Kingella kingae emerged as the most common pathogen in the post-16SPCR period (48.3%), with Staphylococcus aureus being the most frequent overall (37.5%).
- Children with K. kingae-associated SA were younger, presented with less anemia, lower C-reactive protein levels, reduced rates of osteomyelitis, and received shorter antibiotic courses, with a trend towards fewer sequelae.
Conclusions:
- The implementation of 16SPCR significantly improved the diagnosis of Kingella kingae in pediatric septic arthritis.
- Kingella kingae is frequently identified and associated with a milder clinical presentation and better outcomes in children with SA.
- Molecular diagnostic techniques like 16SPCR are vital for accurate diagnosis and effective management of pediatric septic arthritis.
Background:
Kingella kingae is an emergent pathogen causing septic arthritis (SA) in children.The objective of this study was to analyze the etiology of SA in children before and after the implementation of universal 16S rRNA gene polymerase chain reaction and sequencing (16SPCR) in synovial fluid.
Methods:
Children ≤14 years with acute SA from a Madrid cohort (2002-2013) were reviewed. Differences in etiology were analyzed before (period 1) and after (period 2) the implementation of bacterial 16SPCR in 2009. A comparison in epidemiology, clinical syndromes, therapy and outcome between infections caused by K. kingae and other bacteria was performed.
Results:
Bacteria were detected from 40/81 (49.4%) children, with a higher proportion of diagnosis after 16SPCR establishment (period 2, 63% vs. period 1, 31.4%; P = 0.005). The main etiologies were Staphylococcus aureus (37.5%) and K. kingae (35%), although K. kingae was the most common microorganism in P2 (48.3%). Children with K. kingae SA were less likely to be younger than 3 months (0 vs. 42.3%; P < 0.001), had less anemia (21.4 vs. 50%; P = 0.010), lower C-reactive protein (3.8 vs. 8.9 mg/dL; P = 0.039), less associated osteomyelitis (0 vs. 26.9%; P = 0.033), shorter intravenous therapy (6 vs. 15 days; P < 0.001), and had a nonsignificant lower rate of sequelae (0 vs. 30%; P = 0.15) than children with SA caused by other bacteria. However, they tended to have higher rate of fever (86 vs. 57%; P = 0.083).
Conclusions:
K. kingae was frequently recovered in children with SA after the implementation of bacterial 16SPCR, producing a milder clinical syndrome and better outcome. Therefore, the use of molecular techniques may be important for the management of these children.
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