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Kingella kingae in Pediatric Bone and Joint Infections: The Diagnostic Value of Oropharyngeal Testing

Allan Bybeck Nielsen1,2,3, Amalie Hundahl1,2, Mette Holm4

  • 1From the Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet.

The Pediatric Infectious Disease Journal
|February 12, 2026
PubMed

Insights

Oropharyngeal Kingella kingae DNA testing is highly sensitive but not specific for diagnosing bone and joint infections in children. Researchers advise against using this test due to its low specificity in identifying true K. kingae infections.

Area of Science:

  • Pediatric Infectious Diseases
  • Molecular Diagnostics
  • Orthopedic Infections

Background:

  • Kingella kingae is a significant cause of pediatric bone and joint infections (BJI).
  • Accurate and early diagnosis of K. kingae BJI is crucial for effective treatment.
  • Oropharyngeal carriage of K. kingae is common in children, raising questions about its diagnostic utility for BJI.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of detecting Oropharyngeal Kingella kingae DNA in children suspected of having bone and joint infections.
  • To determine the sensitivity and specificity of oropharyngeal K. kingae DNA detection for proven K. kingae BJI.

Main Methods:

  • A study was conducted involving children with suspected bone and joint infections.
  • Oropharyngeal swabs were collected and tested for the presence of Kingella kingae DNA using molecular methods.
  • Diagnostic performance metrics, including sensitivity and specificity, were calculated.

Main Results:

  • Oropharyngeal Kingella kingae DNA was detected in 100% of children with proven K. kingae BJI (sensitivity 100%).
  • The test showed lower specificity, identifying K. kingae DNA in 71% of children with disproven K. kingae BJI.
  • A significant proportion of children without K. kingae BJI also tested positive for oropharyngeal K. kingae DNA.

Conclusions:

  • While highly sensitive, oropharyngeal K. kingae DNA testing demonstrates low specificity for diagnosing K. kingae bone and joint infections in children.
  • The presence of K. kingae DNA in the oropharynx is not a reliable indicator of active BJI.
  • Routine use of oropharyngeal K. kingae DNA testing is not recommended for diagnosing suspected BJI in pediatric patients due to potential for false positives.

Keywords:
bone and joint infectionsdiagnostic valueosteoarticular infectionspediatric

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