1136. Epidemiology and Clinical Features of Kingella Septic Arthritis among Children in NYC
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Kingella Poster IDSA.pdf (702.8 kB)
  • Background: Septic arthritis (SA) is a common and serious infection in children that requires prompt diagnosis and treatment. Kingella kingae has been recognized as an increasingly important cause of SA, especially in children < 4yrs of age.

    Objective: To describe the frequency and characteristics of Kingella infection in pediatric patients admitted with a diagnosis of SA.

    Methods: Retrospective laboratory and chart review of all cases of SA from January 2013 to December 2015 in children admitted to Hospital for Joint Disease (HJD), Tisch and Bellevue Hospitals. Demographic, clinical and laboratory data were collected and reviewed. Groups compared using non-parametric tests, p < 0.05.

    Results: Eighty-two children, ages 1month to 17years, were admitted with a diagnosis of SA. Cultures sent on 58, Kingella PCR on 36 of <4 and 22 of >4. An etiologic agent was found in 58 (71%): 23 Kingella (all diagnosed exclusively by PCR), 14 Lyme, 10 S. aureus, 2 S. pneumonia, 2 S. pyogenes and 2 E. coli. Kingella was the most common etiologic agent in children < 4 years old and Lyme for older patients. No specific bacterial cause was found in 24 cases: 4 had been on antibiotics at the time of joint fluid aspiration, 1 had an indeterminate Kingella PCR and 5 had no PCR. All the Kingella positive cases were < 48 months of age (age range 9 – 25 mos). In this age group, Kingella accounted for 47% of all cases of SA and 64% of cases where Kingella PCR was sent (23/36). Kingella was not found in infants <8mos of age but quickly increased and peaked between ages 12-24mos where 82% of SA cases (where PCR was sent) was PCR+. Most cases of Kingella SA were in children from the Jewish community. In this ethnic group, 77% (20/26) of SA cases in infants < 24 months of age were caused by Kingella, compared to 1/5 of non-Jewish infants, p=0.06.

    Conclusion: Kingella is the most common cause of SA in children < 4 years of age in our population. To diagnosis Kingella SA it is absolutely essential to send joint fluid for Kingella PCR. More research is necessary in order to more precisely understand the factors that affect colonization and invasion of Kingella in our pediatric population.

    Joselito Sanchez, MD and Henry Pollack, MD, Pediatric Infectious Disease, NYU Langone Medical Center, New York, NY

    Disclosures:

    J. Sanchez, None

    H. Pollack, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.