Published on May 8, 2014
Major cause of osteoarticular infections (OAI) in children under 4 years. Belongs to the normal oropharyngeal flora (8-9% asymptomatic carriers) Colonization of the oropharynx is a prerequisite for invasive infections which is mediated by the production of a potent RTX cytotoxin. However diagnosing OAI caused by K. kingae remain challenging (mild clinical, biological and radiological signs and difficult germ cultivation). Kingella kingae:
Study Aim To investigate whether a specific oropharyngeal swab real time PCR (oropharyngeal K. kingae PCR) could improve the recognition of K. kingae OAI in young children. Specific real time PCR targeting the RTX toxin coding DNA of K. kingae
Prospective cohort study of all young children presenting with atraumatic osteoarticular complaints between 2008 and 2011 to our emergency room. Enrolment Clinical evaluation 1st phase investigations 2nd phase diagnostic investigations • Atraumatic OA complaints • Age 6-48 months • Clinical evaluation • CBC, CRP, VS, blood culture • Oropharyngeal K. kingae PCR • MRI • Infection site puncture • Culture, broad range PCR • K. kingae PCR on osteo- articular aspirate Findings suggestive for OAI
K. kingae OAI 30 cases OAI (other) 1 case no OAI 83 cases H. Influenzae 123 patients enrolled 30 orophary. K. kingae PCR + MRI consistent with OAI despite negative microbiology suspected OAI 9 cases 8 orophary. K. kingae PCR + 76 orophary. K. kingae PCR - 9 orophary. K. kingae PCR + Excluded from statistical analysis
Diagnostic performances of the oropharyngeal swab K. kingae specific PCR test (95% CI) Sensitivity 100% (88.4; 100) Specificity 90.5% (82.1; 95.8) Positive predictive value 78.9% (62.7; 90.4) Negative predictive value 100% (95.5; 100)
K. kingae is the 1st microorganism responsible for OAI in children under 4 years (>95% in this study) Detection of K. kingae DNA in oropharyngeal swabs of children with clinical findings of OAI is predictive for K kingae OAI and negative result excludes OAI caused by this bacteria. A valuable non invasive diagnostic tool which may improve the recognition of K. kingae OAI among young children.
Implementation of oropharyngeal K.kingae PCR as diagnostic tool for OAI in our setting: Changed our diagnostic approach Faster recognition of OAI in young children Improved therapeutic management Increased recognition of OAI due to K. kingae
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