The role of Kingella kingae in pre-school aged children with bone and joint infections

Laudi Olijve; Lahiru Amarasena; Emma Best; Christopher Blyth; Mirjam van den Boom; Asha Bowen; Penelope A Bryant; Jim Buttery; Hazel C Dobinson; Joshua Davis; Joshua Francis; Heidi Goldsmith; Elle Griffiths; Te-Yu Hung; Julie Huynh; Alison Kesson; Andrea Meehan; Brendan McMullan; Clare Nourse; Pamela Palasanthiran; Rushi Penumarthy; Katie Pilkington; Janine Searle; Anya Stephenson; Rachel Webb; Jonathan Williman; Tony Walls

doi:10.1016/j.jinf.2021.06.028

The role of Kingella kingae in pre-school aged children with bone and joint infections

J Infect. 2021 Sep;83(3):321-331. doi: 10.1016/j.jinf.2021.06.028. Epub 2021 Jul 12.

Authors

Laudi Olijve¹, Lahiru Amarasena², Emma Best³, Christopher Blyth⁴, Mirjam van den Boom⁵, Asha Bowen⁶, Penelope A Bryant⁷, Jim Buttery⁸, Hazel C Dobinson⁹, Joshua Davis¹⁰, Joshua Francis¹¹, Heidi Goldsmith¹², Elle Griffiths¹³, Te-Yu Hung¹⁴, Julie Huynh¹⁵, Alison Kesson¹⁶, Andrea Meehan¹⁷, Brendan McMullan¹⁸, Clare Nourse¹⁹, Pamela Palasanthiran²⁰, Rushi Penumarthy²¹, Katie Pilkington²², Janine Searle²³, Anya Stephenson²⁴, Rachel Webb²⁵, Jonathan Williman²⁶, Tony Walls²⁷

Affiliations

¹ Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand; Sheffield Teaching Hospitals, UK; Sydney Children's Hospital Randwick, 61 High Street, Randwick, NSW 2031, Australia.
² Department of Paediatrics; Child and Youth Health, National Immunisation Advisory Centre, The University of Auckland, New Zealand.
³ Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, Auckland, New Zealand; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Australia.
⁴ School of Medicine, University of Western Australia, Australia; School of Medicine, University of Western Australia, Australia; Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Department of Microbiology, Pathwest Laboratory Medicine, QEII Medical Centre, Australia; Department of Paediatrics, Christchurch Hospital, Canterbury District Health Board, University of Otago, PO Box 4345, Christchurch Mail Centre, Christchurch 8140, New Zealand.
⁵ Starship Children's Hospital, Auckland, New Zealand; Starship Children's Hospital, Auckland, New Zealand; Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, Locked Bag 2010, Nedlands WA 6909, Australia.
⁶ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Australia; National Health and Medical Research Council, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Australia; Menzies School of Health Research, Charles Darwin University, Australia; Institute for Health Research, The University of Notre Dame Australia, Australia; Dept of General Medicine, The Royal Children's Hospital Melbourne, Victoria, Australia.
⁷ Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infectious Diseases and Hospital-in-the-Home, The Royal Children's Hospital Melbourne, Australia; Infection, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Department of Infection and Immunity, Monash Children's Hospital, Australia.
⁸ Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Monash Centre for Health Care Research and Implementation, Department of Paediatrics, Monash University, Melbourne, 246 Clayton Rd, Clayton 3168, Victoria, Australia; Wellington Regional Hospital, Capital and Coast District Health Board, Department of Paediatrics and Child Health, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand.
⁹ Global Health Division, Menzies School of Health Research, Darwin, Australia.
¹⁰ Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Infectious Diseases, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, NSW 2300, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
¹¹ Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Dr Tiwi NT 0810, Darwin, Australia; John Hunter Children's Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
¹² Queensland Children's Hospital, 501 Stanley Street, South Brisbane 4101, Australia.
¹³ Department of Paediatrics, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi 0810, Northern Territory, Australia.
¹⁴ Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Australia.
¹⁵ Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; Centre for tropical medicine, 764 Vo Van Kiet, District 5 Ho Chi Minh City, Viet Nam; Departments of Infectious Disease and Microbiology, The Children's Hospital at Westmead, Westmead New South Wales, Locked Bag 4001, Westmead 2145, Australia.
¹⁶ Discipline of Child and Adolescent health, University of Sydney, Australia; Discipline of Child and Adolescent health, University of Sydney, Australia; The Marie Bashir Institute of Infectious Diseases and Biosecurrity, University of Sydney, Australia; Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Locked Bag 2010, Nedlands WA 6909, Australia.
¹⁷ Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, Randwick, NSW 2031, Australia.
¹⁸ National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; National Centre for Infections in Cancer, University of Melbourne, Melbourne, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Queensland Children's Hospital, Children's Health Queensland, Level 12, South Brisbane, QLD 4101, Australia.
¹⁹ Faculty of Medicine, University of Queensland, Australia; Faculty of Medicine, University of Queensland, Australia; Department of Immunology and Infectious Diseases, Sydney Children's Hospital Network, Randwick, High Street, Randwick, NSW 2031, Australia.
²⁰ University of New South Wales, UNSW, Kensington, NSW, Australia; University of New South Wales, UNSW, Kensington, NSW, Australia; Counties manukau district health board, Middlemore Hospital, 100 hospital road, Otahuhu 2025, Auckland, New Zealand.
²¹ Monash Children's Hospital, Monash Health, 101/71 Abinger Street, Richmond, VIC 3121, Australia.
²² Department of Paediatrics, the University of Melbourne, Australia; Department of Paediatrics, the University of Melbourne, Australia; Department of General Medicine, The Royal Children's Hospital Melbourne, 50 Flemington Road, Melbourne 3052, Australia.
²³ Starship Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand.
²⁴ University of Auckland, Middlemore Hospital, 100 hospital road, Otahuhu, 2025 Auckland, New Zealand.
²⁵ Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Starship Children's Hospital and KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand; Biostatistics and Computation Biology Unit, University of Otago, 2 Riccarton Avenue, Christchurch, 8140, New Zealand.
²⁶ Department of Paediatrics, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
²⁷ Department of Paediatrics, University of Otago, Christchurch School of Medicine, New Zealand. Electronic address: tony.walls@otago.ac.nz.

PMID: 34265316
DOI: 10.1016/j.jinf.2021.06.028

Abstract

Objectives: The Pre-school Osteoarticular Infection (POI) study aimed to describe the burden of disease, epidemiology, microbiology and treatment of acute osteoarticular infections (OAI) and the role of Kingella kingae in these infections.

Methods: Information about children 3-60 months of age who were hospitalized with an OAI to 11 different hospitals across Australia and New Zealand between January 2012 and December 2016 was collected retrospectively.

Results: A total of 907 cases (73%) were included. Blood cultures grew a likely pathogen in only 18% (140/781). The peak age of presentation was 12 to 24 months (466/907, 51%) and Kingella kingae was the most frequently detected microorganism in this age group (60/466, 13%). In the majority of cases, no microorganism was detected (517/907, 57%). Addition of PCR to culture increased detection rates of K. kingae. However, PCR was performed infrequently (63/907, 7%).

Conclusions: This large multi-national study highlights the need for more widespread use of molecular diagnostic techniques for accurate microbiological diagnosis of OAI in pre-school aged children. The data from this study supports the hypothesis that a substantial proportion of pre-school aged children with OAI and no organism identified may in fact have undiagnosed K. kingae infection. Improved detection of Kingella cases is likely to reduce the average length of antimicrobial treatment.

Keywords: Child; Infections; Kingella kingae; Osteomyelitis; Septic arthritis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthritis, Infectious* / diagnosis
Arthritis, Infectious* / epidemiology
Child
Child, Preschool
Humans
Infant
Kingella kingae* / genetics
Neisseriaceae Infections* / diagnosis
Neisseriaceae Infections* / epidemiology
Polymerase Chain Reaction
Retrospective Studies