Geographic Variations in Incidence of Kingella kingae: Selection Bias or Reality?

The article focuses on the challenges and considerations in diagnosing acute hematogenous osteoarticular infections (OAIs) caused by Kingella kingae in young children, particularly those under 48 months of age. It highlights that during 2006–2016 in the United States, molecular assays for K. kingae were not widely available, potentially leading to underdiagnosis, though some testing was performed at Nationwide Children's Hospital. The incidence of K. kingae in OAIs varies globally, with higher rates reported in Europe and Israel compared to North America, where data are limited and may reflect ascertainment bias. The article also notes that traditional clinical prediction scores may be less effective for K. kingae infections due to their typically mild inflammatory response, emphasizing the need for clinician awareness and appropriate antibiotic selection. Finally, it raises the question of the cost-effectiveness of molecular diagnostics given that standard empiric therapies often cover K. kingae alongside other common pathogens.