Hooper Mary, Morones Matthew, Rosenfeld Scott, Vallejo Jesus G, Kaplan Sheldon L, McNeil J Chase
From the Division of Infectious Diseases, Department of Pediatrics.
Division of Pediatric Orthopedics, Department of Orthopedics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
Pediatr Infect Dis J. 2025 Mar 21;44(8):735-741. doi: 10.1097/INF.0000000000004794.
While Staphylococcus aureus is the most common pathogen causing acute bacterial arthritis (ABA), the microbiology is diverse, particularly in young children. Kingella kingae is a well-known pathogen of ABA and can be particularly difficult to identify. We examined the impact of molecular diagnostics on ABA in a historically methicillin-resistant S. aureus (MRSA) endemic region.
Cases of ABA in children ≤5 years old between 2015 and 2022 were reviewed. The clinical features of cases were compared by causative pathogen. Trends in utilization of molecular diagnostics and rates of pathogen identification were examined.
One hundred sixty-two eligible subjects were identified with a median age of 1.4 years. A pathogen was identified in 76.5%. The most identified pathogen was S. aureus (31.4%) of which 25.5% were MRSA. The next most identified organism was K. kingae (22.8%) followed by Streptococcus pneumoniae (5.6%). During the study period, a temporal increase was observed in the use of molecular diagnostics peaking at 85.7% of cases ( P < 0.001); this was associated with a temporal reduction in the proportion of cases without a pathogen identified. The majority of K. kingae and S. pneumoniae cases were only identified by polymerase chain reaction (PCR)-based methods. MRSA and S. pneumoniae cases were associated with the highest rates of orthopedic sequelae.
While S. aureus remains the principal etiology of ABA in young children, K. kingae and S. pneumoniae are significant pathogens. Pathogen identification is substantially enhanced using molecular diagnostic studies, particularly those capable of detecting K. kingae and S. pneumoniae .
虽然金黄色葡萄球菌是引起急性细菌性关节炎（ABA）最常见的病原体，但微生物学情况多样，尤其是在幼儿中。金氏金杆菌是一种广为人知的ABA病原体，可能特别难以鉴定。我们在一个历史上耐甲氧西林金黄色葡萄球菌（MRSA）流行的地区研究了分子诊断对ABA的影响。
回顾了2015年至2022年间5岁及以下儿童的ABA病例。根据致病病原体比较病例的临床特征。研究了分子诊断的使用趋势和病原体鉴定率。
确定了162名符合条件的受试者，中位年龄为1.4岁。76.5%的病例鉴定出了病原体。鉴定出最多的病原体是金黄色葡萄球菌（31.4%），其中25.5%为MRSA。其次鉴定出最多的微生物是金氏金杆菌（22.8%），其次是肺炎链球菌（5.6%）。在研究期间，观察到分子诊断的使用呈时间性增加，在85.7%的病例中达到峰值（P<0.001）；这与未鉴定出病原体的病例比例的时间性下降相关。大多数金氏金杆菌和肺炎链球菌病例仅通过基于聚合酶链反应（PCR）的方法鉴定。MRSA和肺炎链球菌病例与骨科后遗症的发生率最高相关。
虽然金黄色葡萄球菌仍然是幼儿ABA的主要病因，但金氏金杆菌和肺炎链球菌是重要病原体。使用分子诊断研究可显著提高病原体鉴定，尤其是那些能够检测金氏金杆菌和肺炎链球菌的研究。
