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Updated: Oct 1, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
First documented outbreak of arthritis caused by Kingella kingae in a Spanish childcare center
Borja Guarch-Ibáñez1, Alicia Cabacas2, Juan José González-López3
1Servicio de Pediatría, Hospital Universitari de Girona Dr. Josep Trueta, Universitat de Girona, Girona, Spain.
Insights
Kingella kingae is a common cause of bone infections in young children. This study investigated an outbreak of Kingella kingae arthritis in a Spanish daycare, finding it can spread in such settings.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Kingella kingae (K. kingae) is increasingly recognized as a primary cause of skeletal infections in children aged 6 months to 2 years.
- Invasive K. kingae infections occurring in clusters are uncommon but significant public health events.
- This report details the first documented outbreak of K. kingae-induced arthritis in Spain, involving three cases within a single daycare center.
Purpose of the Study:
- To investigate an outbreak of arthritis caused by Kingella kingae in a Spanish daycare center.
- To assess the prevalence of K. kingae colonization among daycare attendees following the identification of invasive cases.
- To evaluate the effectiveness of antibiotic prophylaxis in eradicating K. kingae colonization.
Main Methods:
- Surveillance throat swabs were collected from daycare attendees (n=9, age 16-23 months) for K. kingae detection using culture and K. kingae-specific RT-PCR.
- Attendees identified as colonized received combined amoxicillin-rifampicin prophylaxis.
- Post-prophylaxis throat swabs were obtained to confirm bacterial eradication.
Main Results:
- K. kingae was detected via RT-PCR in all three index cases and in five of six daycare attendees.
- Culture methods yielded negative results for all tested samples.
- Following antibiotic prophylaxis, three toddlers remained positive for K. kingae via RT-PCR, indicating partial eradication.
Conclusions:
- Invasive K. kingae infections can manifest as outbreaks in closed communities like daycare centers.
- Enhanced awareness and sensitive diagnostic methods are crucial for identifying and managing K. kingae outbreaks.
- Prophylactic antibiotics may partially reduce K. kingae colonization, and no further cases of disease were observed post-intervention.
Background:
Recently, Kingella kingae (K. kingae) has been described as the most common agent of skeletal system infections in children 6 months-2 years of age. More exceptional is the clinical presentation in clusters of invasive K. kingae infections. We describe the investigation of the first outbreak of 3 cases of arthritis caused by K. kingae documented in Spain detected in a daycare center in Roses, Girona.
Patients And Methods:
In December of 2015 surveillance throat swabs obtained from all attendees from the same class of the index daycare center were assessed to study the prevalence of K. kingae colonization. The sample was composed of 9 toddlers (range: 16-23 months of age). Investigation was performed by culture and K. kingae-specific RT-PCR. Combined amoxicillin-rifampicin prophylaxis was offered to all attendees who were colonized by K. kingae. Following antimicrobial prophylaxis, a new throat swab was taken to confirm bacterial eradication.
Results:
K. kingae was detected by RT-PCR throat swabs in the 3 index cases and 5 of the 6 daycare attendees. Cultures were negative in all cases. After administration of prophylactic antibiotics, 3 toddlers were still positive for K. kingae-specific RT-PCR.
Conclusions:
Clusters of invasive K. kingae infections can occur in daycare facilities and closed communities. Increased awareness and use of sensitive detection methods are needed to identify and adequately investigate outbreaks of K. kingae disease. In our experience, the administration of prophylactic antibiotics could result in partial eradication of colonization. No further cases of disease were detected after prophylaxis.
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