Verdier Isabelle, Gayet-Ageron Angèle, Ploton Christine, Taylor Patricia, Benito Yvonne, Freydiere Anne-Marie, Chotel Franck, Bérard Jérôme, Vanhems Philippe, Vandenesch François
Laboratoire de Bactériologie, Hôpital Cardiologique Louis Pradel, Lyon, France.
Pediatr Infect Dis J. 2005 Aug;24(8):692-6. doi: 10.1097/01.inf.0000172153.10569.dc.
Microbiologic diagnosis of septic arthritis and osteomyelitis in children is hindered by the less than optimal yield of blood and osteoarticular fluid cultures.
All patients admitted to a pediatric unit for osteoarticular infections (OAI) between January 2001 and February 2004 were enrolled in this prospective study. Osteoarticular fluid and biopsy samples that were negative by conventional culture were tested by polymerase chain reaction (PCR) with universal 16S ribosomal DNA primers.
We enrolled 171 children. Culture was positive in 64 cases (37.4%), yielding Kingella kingae in 9 cases. The 107 culture-negative specimens were tested by 16S ribosomal DNA PCR. Fifteen samples (14%) were positive, all for Kingella DNA sequences. K. kingae was the second cause of OAI in this population (30.4%), after Staphylococcus aureus (38%). Patients with Kingella infection diagnosed by culture (9 cases) did not differ from those diagnosed by PCR (15 cases) in terms of their clinical characteristics (including prior antibiotic therapy). The characteristics of the 24 children with arthritis (n = 17) or osteomyelitis (n = 7) were similar to those reported elsewhere. Fever (>38 degrees C) and symptom onset shortly before hospitalization (median, 4.5 days) were significantly associated with arthritis.
Use of molecular diagnostic methods increases the identification of K. kingae in osteoarticular infections.
儿童脓毒性关节炎和骨髓炎的微生物学诊断因血液和骨关节液培养的阳性率不理想而受到阻碍。
2001年1月至2004年2月期间入住儿科病房的所有骨关节感染（OAI）患者均纳入本前瞻性研究。对常规培养阴性的骨关节液和活检样本，采用通用16S核糖体DNA引物通过聚合酶链反应（PCR）进行检测。
我们纳入了171名儿童。培养阳性64例（37.4%），其中9例培养出金氏金杆菌。对107份培养阴性的标本进行16S核糖体DNA PCR检测。15份样本（14%）呈阳性，均为金氏金杆菌DNA序列。在该人群中，金氏金杆菌是骨关节感染的第二大病因（30.4%），仅次于金黄色葡萄球菌（38%）。通过培养诊断为金氏金杆菌感染的患者（9例）与通过PCR诊断的患者（15例）在临床特征（包括先前的抗生素治疗）方面没有差异。24例患有关节炎（n = 17）或骨髓炎（n = 7）的儿童的特征与其他地方报道的相似。发热（>38℃）和住院前不久出现症状（中位数为4.5天）与关节炎显著相关。
使用分子诊断方法可提高骨关节感染中金氏金杆菌的检出率。
