Advances in Kingella kingae: related osteoarticular infections in children
10.3760/cma.j.cn121113-20240218-00099
- VernacularTitle:金氏杆菌相关儿童骨关节感染的研究进展
- Author:
Xingguang CHEN
1
;
Jue LIU
;
Xiaodong WANG
Author Information
1. 嘉兴市第二医院骨科，嘉兴 314000
- Keywords:
Kingella kingae;
Child;
Arthritis, infectious;
Osteomyelitis
- From:
Chinese Journal of Orthopaedics
2024;44(17):1176-1183
- CountryChina
- Language:Chinese
-
Abstract:
Kingella kingae (K. kingae) is a facultative anaerobic gram-negative bacterium that primarily colonizes the oropharynx of infants and young children. The difficulty of isolating this organism using traditional culture methods has led to underreporting, especially in developing countries. Advances in nucleic acid amplification tests, including 16S rRNA PCR and specific PCR for K. kingae, have significantly enhanced detection sensitivity in Western developed countries. K. kingae is now recognized as the leading pathogen in osteoarticular infections (OAIs) among children aged 6-48 months, overtaking Staphylococcus aureus (S. aureus). Children affected by K. kingae OAIs often present with septic arthritis and osteomyelitis, and occasionally with conditions such as pyogenic spondylitis/discitis, pyogenic tenosynovitis, pyogenic sacroiliitis, and chest wall osteoarticular infections. These infections generally exhibit a slow progression, mild to moderate symptoms, and respond well to effective antibiotic therapy, resulting in favorable outcomes. Given the challenges of obtaining joint fluid or purulent samples from young children without anesthesia, some scholars recommend predictive models based on serological results or imaging examinations to identify K. kingae infections. However, these methods have practical limitations. Most K. kingae-related OAIs can be managed non-surgically with intravenous antibiotic therapy. In regions where K. kingae identification is feasible, β-lactam antibiotics are the treatment of choice. Otherwise, empirical therapy should cover both K. kingae and S. aureus, particularly in children aged 6-48 months. In areas with a high prevalence of methicillin-resistant S. aureus, combination therapy with vancomycin may be warranted. Investigating the carriage rate of K. kingae among Chinese children and its detection rate in OAIs could simplify treatment procedures, improve outcomes, and optimize antibiotic use, highlighting its significant clinical importance.
