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Septic Arthritis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Most cases of septic arthritis are monomicrobial, with Staphylococcus aureus being the most common pathogen. This includes both methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA). This is followed by other Gram-positive organisms, most often streptococci including Streptococcus pyogenes (associated with skin and soft tissue infection, IV drug users and trauma), Streptococcus agalactiae (more common in diabetics and immune compromised individuals) and Streptococcus pneumoniae (associated with alcoholism). Staphylococcus epidermidis, in its ability to form biofilms, is the most common agent associated with prosthetic joint infection. Other bacteria increase in importance in certain risk groups, but even in these groups, Staphylococcus aureus and streptococci are the most frequently isolated pathogens. The exception to this is in children under 2 years of age, where Kingella kingae is the most common pathogen.
Benzylpenicillin (Penicillin G)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Alasdair M. Geddes, Ian M. Gould, Jason A. Roberts, Jason A. Trubiano, M. Lindsay Grayson
Acinetobacter spp. are Pen G resistant. Moraxella catarrhalis (Branhamella catarrhalis) may be Pen G sensitive, but most strains are Pen G resistant as a result of beta-lactamase production (Jorgensen et al., 1990). Other Moraxella spp. are usually Pen G susceptible (Graham et al., 1990). Kingella kingae is a Gram-negative coccobacillus that occasionally causes human infections such as endocarditis and septic arthritis that is always Pen G sensitive (Morrison and Wagner, 1989; Meis et al., 1992). Actinobacillus actinomycetemcomitans, a rod-shaped coccobacillus, a human pathogen in periodontal disease and also a rare cause of other infections such as endocarditis, is generally Pen G sensitive, but some strains have rather high MICs and some are completely resistant (Kaplan et al., 1989b; Pavicic et al., 1992; Collazos et al., 1994).
Infection
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
The causal organism in both adults and children is usually Staphylococcus aureus (found in over 70% of cases), and less often one of the other Gram-positive cocci, such as the Group A beta-haemolytic streptococcus (Streptococcus pyogenes) which is found in chronic skin infections, as well as Group B streptococcus (especially in newborn babies) or the alphahaemolytic diplococcus S. pneumoniae. In children between 1 and 4 years of age, the Gram-negative Haemophilus influenzae used to be a fairly common pathogen for osteomyelitis and septic arthritis, but the introduction of H. influenzae type B vaccination in the 1990s has been followed by a much reduced incidence of this infection in many countries. In recent years its place has been taken by the increasing presence of Kingella kingae, mainly following upper respiratory infection in young children. Other Gram-negative organisms (e.g. Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis and the anaerobic Bacteroides fragilis) occasionally cause acute bone infection. Curiously, patients with sickle-cell disease are prone to infection by Salmonella typhi. Anaerobic organisms (particularly Peptococcus magnus) have been found in patients with osteomyelitis, usually as part of a mixed infection. Unusual organisms are more likely to be found in heroin addicts and as opportunistic pathogens in patients with compromised immune defence mechanisms.
Novel strategies to diagnose prosthetic or native bone and joint infections
Published in Expert Review of Anti-infective Therapy, 2022
Alex Van Belkum, Marie-Francoise Gros, Tristan Ferry, Sebastien Lustig, Frédéric Laurent, Geraldine Durand, Corinne Jay, Olivier Rochas, Christine C. Ginocchio
Septic arthritis is an inflammation of a joint that is caused by infection. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. Risk factors for septic arthritis include hematogenous spread of pathogens (due to skin infection, cutaneous ulcers, or adjacent osteomyelitis), direct inoculation of pathogens (penetrating trauma, intrauricular injection, recent joint surgery) and higher age. Early stages of the disease include soft tissue swelling, purulence, and widening of joint space. If the disease is untreated it can progress to cartilage destruction, narrowing and irregularity of the joint space, bone destruction, and growth disturbances. Symptoms include pain, fever, restricted movement, swelling, effusion, and erythema. This category of infections is frequently culture negative (between 4.5% and 64%) [13]. Microorganisms involved most commonly are Staphylococcus aureus, coagulase-negative staphylococci, streptococci, enterococci, and several species of gram-negative bacteria and anaerobes. Acute arthritis in children less than 4 years old is frequently due to Kingella kingae and requires rapid antibiotic administration [14]. Neisseria gonorrhoeae, Neisseria meningitidis, or Mycobacterium spp. are less frequently isolated from arthritic patients [15]. Diagnosis mostly relies on arthrocentesis, i.e. joint fluid punctate analysis [16]. Synovial fluid examination includes microbiological, histological, and biochemical analyses. Time to result is key to rapidly initiating targeted antibiotic therapy.
Kingella kingae: from oropharyngeal carriage to paediatric osteoarticular infections
Published in Expert Review of Anti-infective Therapy, 2018
Raimonda Valaikaite, Nawal El Houmami, Vasiliki Spyropoulou, Gabriel Braendle, Dimitri Ceroni
Advances in knowledge about Kingella kingae, and, above all, the dedication of Pablo Yagupsky for studying this pathogen, have drastically clarified the role of K. kingae as a predominant cause of invasive infections in paediatrics. Kingella kingae is currently considered as the primary etiology of osteoarticular infections (OAI) in children aged 6–48 months [1], and a novel agent of outbreaks of invasive disease in day care centers [2]. Osteoarticular infections caused by K. kingae remain difficult to identify with classical diagnostic strategies, because this organism is notoriously fastidious to cultivate. Considering the recent medical advances and innovative approaches for the diagnosis of the disease, partly based on the significantly high detection rate of the organism in the oropharynx of ill children [3], an increase in the number of identified cases could be established worldwide [4].
Evaluation of dual target-specific real-time PCR for the detection of Kingella kingae in a Danish paediatric population
Published in Infectious Diseases, 2018
Victoria Elizabeth de Knegt, Gitte Qvist Kristiansen, Kristian Schønning
With the introduction of sensitive molecular diagnostic techniques, Kingella kingae (K. kingae) has become accepted as a prominent pathogen in the paediatric population [1]. It plays an important role in paediatric osteoarticular infections (OAI), including septic arthritis, osteomyelitis, and spondylodiscitis, as well as occult bacteraemia [2–5]. Cases of K. kingae meningitis and endocarditis in children have also been documented [6,7]. Kingella kingae was initially considered a rare cause of invasive infections, but with the development of better microbiological detection techniques, it has come to be accepted as the most common cause of septic arthritis and osteomyelitis in children under the age of four [1,2,8–11].