The age, sex, and seasonal distributions of invasive Kingella kingae infections in southern Israel were examined and compared to the epidemiology of respiratory carriage of the organism. Medical records of all patients diagnosed between 1988 and 2002 were reviewed, and 2,044 oropharyngeal specimens were cultured on selective media during two periods (February to May and October to December) in 2001. Invasive infections significantly affected children (73 of 74 patients [98.6%] were younger than 4 years), 50 patients (67.8%) were males (P ‫؍‬ 0.045), and 55 episodes (74.3%) occurred between July and December (P ‫؍‬ 0.004). Carriage was higher in the 0-to 3-year-old group and decreased with increasing age (P for trend ‫؍‬ 0.0008). Carriage rates were similar in both sexes and did not significantly differ between the February-to-May and October-toDecember periods. The highest rate of carriage of K. kingae coincided with the age (less than 4 years) at which invasive infections were especially frequent. The peculiar sex and seasonal distributions of invasive disease, however, cannot be readily explained by the epidemiology of respiratory carriage. Viral infections and other yet-to-be-defined cofactors may play a role in the causation of invasive K. kingae infections.For most of the four decades that elapsed since the first characterization of Kingella kingae, this gram-negative bacterium was considered a rare cause of human disease and therefore was mostly neglected (5,8,20). In recent years, as the result of improved isolation techniques, there has been an increasing number of reports on invasive K. kingae infections in the United States, Western Europe, and Israel, suggesting that the organism is an important cause of bacteremia and septic arthritis in pediatric patients (2,4,6,7,13,14,21,22,25). Moreover, studies conducted to elucidate the natural niche of K. kingae have shown that the organism is a frequent component of the oropharyngeal flora of young children and is readily transmitted from person to person among day care center (DCC) attendees (19,24).Despite the enlarging body of information on the clinical and diagnostic aspects of K. kingae infections, the epidemiology of the organism remains largely unknown. A study was performed to investigate the sex, age, and seasonal distributions of invasive K. kingae infections and to correlate these data with the respiratory carriage of the organism. MATERIALS AND METHODSSoroka University Medical Center (SUMC) is a 950-bed university hospital located in the city of Beer-Sheva and is the only medical facility providing inpatient medical services to the entire population of southern Israel (450,000 inhabitants). The Clinical Microbiology Laboratory (CML) of SUMC provides diagnostic microbiology services to hospitalized patients and to the outpatient population of 139 community clinics in the area.Bacteriological methods. Patients referred to the emergency department or hospitalized at SUMC with a febrile illness undergo routine blood cultures with the BACTEC system (B...

The antimicrobial drug susceptibilities of 145 isolates of Kingella kingae to eight antibiotics were determined by the disc diffusion method. In addition, penicillin MICs were determined by the Etest. Study isolates included 37 from blood, 34 from the skeletal system and 74 from respiratory carriers. All isolates were beta-lactamase negative and susceptible to erythromycin, gentamicin, chloramphenicol, tetracycline and ciprofloxacin. A single isolate exhibited resistance to trimethoprim-sulphamethoxazole, and 56 (38.6%) were resistant to clindamycin. The penicillin MIC(50) was 0.023 mg/L and the MIC(90) was 0.047 mg/L. The distribution of MIC values did not differ according to the site of isolation.

Background: In recent years, novel fluoroquinolones with improved activity against gram-positive organisms have been introduced into clinical practice. These drugs may be of potential benefit for the treatment of pneumococcal otitis media, including infections caused by organisms resistant to conventional drugs. Methods: In vitro activity of 6 fluoroquinolones against 77 pneumococcal isolates from middle-ear fluid was determined by the E test. Results: Resistance to penicillin, co-trimoxazole, erythromycin, clindamycin, and tetracycline was present in 59 (76.6%), 47 (61.0%), 19 (24.7%), 11 (14.3%), and 17 (22.1%) isolates, respectively. Fluoroquinolone MIC₅₀ and MIC₉₀ (in µg/ml) were as follows: ciprofloxacin: 1.0 and 3.0, levofloxacin: 0.75 and 1.0, sparfloxacin: 0.25 and 0.38, grepafloxacin: 0.25 and 0.38, trovafloxacin: 0.094 and 0.125, and moxifloxacin: 0.19 and 0.25, respectively. Conclusions: Novel fluoroquinolones and especially trovafloxacin and moxifloxacin appear to be of potential value for the treatment of acute otitis media caused by pneumococci resistant to traditional antibiotics.