7ème Journée de la recherche clinique : Diagnosing Kingella kingae Osteoarticular infectons in young children

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Information about 7ème Journée de la recherche clinique : Diagnosing Kingella kingae...
Health & Medicine

Published on May 8, 2014

Author: Hopitaux_unige

Source: slideshare.net

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DIAGNOSING Kingella kingae OSTEOARTICULAR INFECTIONS IN YOUNG CHILDREN VIA SPECIFIC OROPHARAYNGEAL SWAB PCR de R. Anderson1, V. Dubois-Ferrière1, A. Cherkaoui2, S Manzano3, J. Schrenzel2, D. Ceroni1 1Service of Pediatric Orthopedics, 2Service of Infectious Diseases, 3 Emergency room, University Hospital of Geneva, Switzerland

 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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