Kingella kingae: An Emerging Pathogen of Acute Osteoarticular Infections in Children

Abstract

To the Editor.—We read with interest the Pediatrics electronic pages article by Kiang et al,1“Outbreaks of Osteomyelitis/Septic Arthritis Caused by Kingella kingae Among Child Care Center Attendees.” K kingae has emerged as an important pathogen of acute osteoarticular infections in children. It may be responsible for up to 50% of previously undiagnosed suppurative bone and joint infections in children <2 years of age.2 The bacteriologic data of clinically suspected osteoarticular infections affecting 406 children hospitalized in the pediatric orthopedic surgical unit of the Necker-Enfants Malades Hospital (Paris, France) during a 3.5-year period (1999–2002) were reviewed retrospectively.3 The bacterial cultures from clinical specimens were positive in 74 cases (18%): 38 cases of septic arthritis and 36 cases of bone infections (osteitis, osteomyelitis, or osteoarthritis). The most commonly recovered pathogen was Staphylococcus aureus (44%) followed by K kingae (14%), Streptococcus pyogenes (10%), and Streptococcus pneumoniae (10%). K kingae was isolated most frequently among children <36 months of age.In recent years, there have been an increasing number of reports on osteoarticular infections caused by K kingae in young children,1,3 which may be the result of improved isolation techniques and clinical suspicion (eg, infection among child care center attendees,1 arthritis following stomatitis4). Recovery of this fastidious bacterium can be improved significantly by inoculation of synovial fluid and bone exudates into an aerobic blood-culture bottle with a continuous monitoring system and holding-culture plates for up to 7 days.5 Physicians who are caring for children with skeletal infections should be aware of this fastidious organism.