From the Pediatric Infectious Diseases Unit.
Pediatric Orthopedics Unit.
Pediatr Infect Dis J. 2018 Dec;37(12):1211-1216. doi: 10.1097/INF.0000000000002068.
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.
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.
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).
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.
金氏金菌是一种引起儿童化脓性关节炎（SA）的新兴病原体。本研究的目的是分析在滑液中实施通用 16S rRNA 基因聚合酶链反应和测序（16SPCR）前后，儿童 SA 的病因。
回顾了来自马德里队列的 2002-2013 年≤14 岁患有急性 SA 的儿童。分析了 2009 年实施细菌 16SPCR 前后（时期 1 和时期 2）病因的差异。比较了金氏金菌感染与其他细菌感染的流行病学、临床综合征、治疗和结局。
40/81（49.4%）例患儿从滑液中检出细菌，16SPCR 建立后诊断比例更高（时期 2，63% vs. 时期 1，31.4%；P=0.005）。主要病原体为金黄色葡萄球菌（37.5%）和金氏金菌（35%），但金氏金菌在 P2 中更为常见（48.3%）。金氏金菌 SA 患儿年龄小于 3 个月的可能性较小（0% vs. 42.3%；P<0.001），贫血程度较轻（21.4% vs. 50%；P=0.010），C 反应蛋白水平较低（3.8 vs. 8.9mg/dL；P=0.039），合并骨髓炎的比例较低（0% vs. 26.9%；P=0.033），静脉治疗时间较短（6 天 vs. 15 天；P<0.001），后遗症发生率无显著差异（0% vs. 30%；P=0.15），但发热发生率较高（86% vs. 57%；P=0.083）。
在滑液中实施细菌 16SPCR 后，儿童 SA 中经常检测到金氏金菌，其临床表现较轻，结局较好。因此，分子技术的应用可能对这些儿童的治疗具有重要意义。
