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Systematic Review of Kingella kingae Musculoskeletal Infection in Children: Epidemiology, Impact and Management Strategies

Authors Wong M, Williams N, Cooper C

Received 29 May 2019

Accepted for publication 7 December 2019

Published 24 February 2020 Volume 2020:11 Pages 73—84


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Roosy Aulakh

Maria Wong, 1 Nicole Williams, 1, 2 Celia Cooper 3

1Department of Orthopaedic Surgery, Women and Children’s Hospital, Adelaide, SA, Australia; 2Center for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA, Australia; 3Department of Infectious Diseases, Women and Children’s Hospital, Adelaide, SA, Australia

Correspondence: Nicole Williams
Department of Orthopaedic Surgery, Women and Children’s Hospital, 72 King William Rd, North Adelaide, SA 5006, Australia
Tel +61 8 8161 7223
Fax +61 8 8161 057

Abstract: Kingella kingae, a pathogen often responsible for musculoskeletal infections in children is the most common cause of septic arthritis and osteomyelitis in children 6 to 36 months of age. The aim of this study was to perform a systematic review of previous studies to determine the proportion of K. kingae in bacteriologically proven musculoskeletal infections among the pediatric population. A secondary objective was to describe the diagnostic strategies and outcome of patients with musculoskeletal infections caused by K. kingae. A systematic review was conducted to identify publications that report on musculoskeletal infections caused by K. kingae in the pediatric population (patients 0 to < 18 years old with microbiologic culture and/or polymerase chain reaction (PCR) confirmation of K. kingae and a description of the musculoskeletal infection involved). Of 144 studies included in this review, we sought to determine the proportion of K. kingae pediatric musculoskeletal infections. A total of 711 (30.8%) out of 2308 pediatric cases with culture and/or PCR proven musculoskeletal infections had K. kingae successfully identified from twenty-nine studies. Of the 1070 patients who were aged less than 48 months, K. kingae was the organism identified in 47.6% of infections. We found the average age from the collated studies to be 17.73 months. Of 520 pediatric musculoskeletal patients in which K. kingae infections were identified and where the studies reported the sites of infection, a large proportion of cases (65%) were joint infections. This was followed by 18.4% osteoarticular infection (concomitant bone and joint involvement), with isolated bone and spine at 11.9% and 3.5%, respectively. Twenty-one papers reported clinical and laboratory findings in children with confirmed K. kingae infection. The median temperature reported at admission was 37.9°C and mean was 38.2°C. Fourteen studies reported on impact and treatment, with the majority of children experiencing good clinical outcome and function following antibiotic treatment with no serious orthopaedic sequelae.

Keywords: Kingella kingae, osteoarticular infection, septic arthritis, osteomyelitis, spondylodiscitis

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