Kingella kingae is recognized increasingly
as a cause of skeletal infections in children.1 Recent
studies indicate that direct inoculation of clinical specimens into aerobic
blood culture bottles (ABCBs), instead of direct plating of specimens on solid
media, might improve recovery of the fastidious bacteria.2,3 Prompted
by a report of a possible cluster of osteoarticular infections caused by K. kingae among children, the Infectious Diseases Society
of America Emerging Infections Network (IDSA-EIN) surveyed pediatric infectious
disease consultants (PIDCs) about their experiences in diagnosing K. kingae and other skeletal infections in children. This report summarizes
the findings of that survey, which identified 23 K. kingae pediatric cases and indicated that 35% of responding PIDCs did not
use ABCBs in diagnosing skeletal infections. Efforts to increase use of ABCBs
among clinicians and laboratorians might lead to increased detection of K. kingae cases.
In November 2002, a questionnaire was distributed to PIDCs in IDSA-EIN.
This query aimed to (1) identify the diagnostic approaches of PIDCs in evaluating
skeletal infections in children and (2) determine the number of cases and
types of infections attributed to K. kingae diagnosed
by these physicians during June 2001–November 2002. Of 254 PIDCs surveyed,
156 (61%) responded.
During June 2001–November 2002, PIDCs diagnosed skeletal infections,
including septic arthritis, osteomyelitis, diskitis, tenosynovitis, and dactylitis,
in 1,908 patients aged <5 years. For these cases, 56 (43%) PIDCs reported
no organism found in ≤25% of their cases, 43 (33%) in ≤50% of their
cases, and 24 (18%) in >50% of their cases. Eighteen (12%) PIDCs diagnosed
23 cases of K. kingae infection: septic arthritis
(12), osteomyelitis (nine), endocarditis (one), and bacteremia (one). Median
age of patients was 2.3 years (range: 0.5-10.0 years); no K. kingae case clusters were reported. At diagnosis, four persons had
upper respiratory tract infections, and one had stomatitis.
When diagnosing skeletal infections, the majority (97 [62%]) of PIDCs
requested that specimens be inoculated into ABCBs for some (55 [35%]) or all
(42 [27%]) of their cases; 55 (35%) PIDCs never made that request. The most
common specimens inoculated into ABCBs were synovial fluid (78 [80%]) and
bone aspirate (49 [51%]). Of those using ABCBs, 53 (54%) had been making this
request for <5 years. Of all respondents, 89 (57%) were aware that use
of ABCBs might improve isolation of this organism and subsequent identification.
PIDCs reported several barriers to use of ABCBs in diagnosing skeletal infections,
including (1) specimens obtained for diagnosis commonly being taken before
consulting PIDCs and (2) laboratories being unwilling to perform requested
This survey identified 23 K. kingae pediatric
cases; the majority (91%) of infections were either septic arthritis or osteomyelitis.
When diagnosing skeletal infections, 43% of PIDCs reported that no organism
was found in <25% of cases; 38% of PIDCs did not use ABCBs for recovery
of K. kingae. Several studies have indicated that
commercial blood-culture systems improve the recovery of K. kingae from synovial fluid.2,3 Increased
use of ABCBs might reveal K. kingae to be a more
common cause of skeletal infections. Educational efforts to improve the selection
of diagnostic methods for infectious diseases should be targeted not only
to infectious disease consultants but also to clinical microbiology laboratorians
and those physicians most likely to obtain specimens (e.g., orthopedic surgeons
for skeletal infections).
Infectious Diseases Society of America Emerging Infections Network.
L Strausbaugh, MD, L Liedtke, MS, Veterans Affairs Medical Center and Oregon
Health and Science Univ, Portland, Oregon. J Hageman, MHS, A Khaw, MD, D Jernigan,
MD, Div of Healthcare Quality Promotion, National Center for Infectious Diseases,
Brief Report:. JAMA. 2004;292(1):34. doi:10.1001/jama.292.1.34