Beta-lactamase production by Kingella kingae in Israel is clonal and common in carriage organisms but rare among invasive strains

The purpose of this study was to investigate the prevalence of β-lactamase and the genomic clonality of a large collection of Kingella kingae isolates from Israeli patients with a variety of invasive infections and asymptomatic pharyngeal carriers. β-lactamase production was studied by the nitrocefin method and the minimum inhibitory concentrations (MICs) of penicillin and amoxicillin–clavulanate were determined by the epsilon (Etest) method. The genotypic clonality of isolates was investigated by pulsed-field electrophoresis (PFGE). β-lactamase was found in 2 of 190 (1.1 %) invasive isolates and in 66 of 429 (15.4 %) randomly chosen carriage organisms (p < 0.001). Overall, 73 distinct PFGE clones were identified (33 among invasive organisms and 56 among carriage isolates). β-lactamase production was found to be limited to four distinct PFGE clones, which were common among carriage strains but rare among invasive strains, and all organisms in the collection belonging to these four clones expressed β-lactamase. The penicillin MIC of β-lactamase-producing isolates ranged between 0.094 and 2 mcg/mL (MIC₅₀: 0.25 mcg/mL; MIC₉₀: 1.5 mcg/mL) and that of amoxicillin–clavulanate between 0.064 and 0.47 mcg/mL (MIC₅₀: 0.125 mcg/mL; MIC₉₀: 0.125 mcg/mL). The penicillin MIC of β-lactamase non-producing isolates ranged between <0.002 and 0.064 mcg/mL (MIC₅₀: 0.023 mcg/mL; MIC₉₀: 0.047 mcg/mL). Although β-lactamase production is prevalent among K. kingae organisms carried by healthy carriers, the low invasive potential of most colonizing clones results in infrequent detection of the enzyme in isolates from patients with clinical infections. The exceptional presence of β-lactamase among invasive organisms correlates with the favorable response of K. kingae infections to the administration of β-lactamase-susceptible antibiotics.