title: Outbreak of Kingella kingae skeletal system infections in children in daycare.
abstract: OBJECTIVE
  The objective of this study is to describe the investigation of an outbreak of one culture-proven and two presumptive cases of Kingella kingae osteomyelitis detected within a 15-day period in a daycare center in Israel.
  
  
  METHODS
  Surveillance pharyngeal cultures were obtained from all attendees at the index daycare center and from two neighboring facilities. Combined amoxicillin-rifampin prophylaxis was administered to all children aged 6 to 30 months living in the community. K. kingae isolates were typed by pulsed field gel electrophoresis, random amplified polymorphic DNA analysis and sequencing of the rRNA genes.
  
  
  RESULTS
  Surveillance cultures showed that four of 11 attendees at the index facility as well as five of 12 and one of 15 attendees at neighboring daycare centers carried K. kingae. Typing of isolates showed that the isolate from a child with osteomyelitis was identical to all other isolates from the same daycare center and different from organisms derived from the other facilities. Administration of prophylactic antibiotics resulted in partial eradication of the organism.
  
  
  CONCLUSIONS
  Dissemination of K. kingae in a susceptible pediatric population may result in an outbreak of invasive disease. Our experience suggests the need for increased alertness for clusters of K. kingae infections among children in daycare.
authors.affiliation: Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. yagupsky@bgumail.bgu.ac.il
authors.forename: Pablo
authors.initials: P
authors.lastname: Yagupsky
authors.forename: Yifat
authors.initials: Y
authors.lastname: Erlich
authors.forename: Slonim
authors.initials: S
authors.lastname: Ariela
authors.forename: Ronit
authors.initials: R
authors.lastname: Trefler
authors.forename: Nurith
authors.initials: N
authors.lastname: Porat
mesh_terms: D017677:Age Distribution; D002656:Child Day Care Centers; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D017882:Kingella kingae / Q000302:isolation & purification*; D008297:Male; D016870:Neisseriaceae Infections / Q000175:diagnosis / Q000453:epidemiology*; D011336:Probability; D012720:Severity of Illness Index; D017678:Sex Distribution