JOURNAL OF CLINICAL MICROBIOLOGY, Nov. 2005, p. 5832
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0095-1137/05/$08.00⫹0 doi:10.1128/JCM.43.11.5832.2005
Vitek 2 Automated Identification System and Kocuria kristinae
We have read with great interest the article by Ben-Ami et
al. (2) about the misidentification of coagulase-negative staph-
ylococci (CNoS) as Kocuria spp. by the Vitek 2 system (bi-
oMérieux, Marcy l’Etoile, France). They warned that a clinical
specimen growing Kocuria should raise suspicion of CNoS in-
fection. In their study, they made use of the Vitek 2 ID GPC
gram-positive identification card. In our laboratory, we had
similar experiences with the use of this card. However, a new
Vitek 2 gram-positive identification card GP and database
were recently introduced by bioMérieux. This GP card allows
for the identification of additional taxa. The species Kocuria
kristinae is one of these. Funke et al. (3) recently reported in
this journal the performance of this new GP card for the
identification of gram-positive cocci from clinical specimen.
Although they reported that the GP card performed well in a
routine clinical laboratory, they warned that their evaluation
covered only the most frequently encountered gram-positive
cocci and that additional evaluation of rare taxa is recom-
mended.
Recently, we have encountered two isolates from two pa-
tients that were identified as Kocuria kristinae by the Vitek 2
GP card. The first isolate came from the aortofemoral vascular
graft of a 78-year-old man. The graft was cultured in Wilkins-
Chalgren broth and yielded growth of gram-positive cocci after
7 days of incubation. The second isolate came from pericardial
fluid of a 61-year-old man. It was cultured in a BacT/ALERT
PF bottle (bioMérieux) and yielded growth after 2 days of
incubation. The identifications were confirmed on the basis of
the following manual tests: facultative anaerobe, nonmotile,
catalase-positive, gram-positive cocci arranged in tetrads on
Gram staining and pale cream nonhemolytic colonies on blood
agar, negative nitrate reduction, positive esculin hydrolysis,
anaerobic acid from glucose, bacitracin susceptibility at 0.04 U,
and furazolidone resistance at 100 ␮g. Analysis of the cellular
fatty acid composition revealed that the two isolates had large
amounts of anteiso-C15:0 and smaller amounts of C16:0, iso-
C16:0, and anteiso-C17:0, which is compatible with Kocuria kris-
tinae (4). Analysis of the 16S rRNA sequences was performed
as described previously by Wauters et al. (5), and he confirmed
the identification of the two isolates.
In both cases, the isolates probably reflected contamination,
since both patients were doing well in the absence of antimi-
crobial therapy. Kocuria kristinae is part of the flora of the skin
and oral cavity. Infection due to Kocuria spp. is exceedingly
rare. Infection due to Kocuria kristinae has only been reported
once in an ovarian cancer patient with catheter-related bacte-
remia (1).
We believe that these cases illustrate that with use of the
Vitek 2 GP card a reliable identification of Kocuria kristinae is
possible. Also, use of this card in the routine microbiology
laboratory could lead to a better understanding of the potential
pathogenicity of this species.
We are grateful to G. Wauters for performing the 16S rRNA gene
sequencing.
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Vol. 43, No.
REFERENCES
1. Basaglia, G., E. Carretto, D. Barbarini, L. Moras, S. Scalone, P. Marone, and
P. De Paoli. 2002. Catheter-related bacteremia due to Kocuria kristinae in a
patient with ovarian cancer. J. Clin. Microbiol. 40:311–313.
2. Ben-Ami, R., S. Navon-Venezia, D. Schwartz, Y. Schlezinger, Y. Mekuzas, and
Y. Carmeli. 2005. Erroneous reporting of coagulase-negative staphylococci as
Kocuria spp. by the Vitek 2 system. J. Clin. Microbiol. 43:1448–1450.
3. Funke, G., and P. Funke-Kissling. 2005. Performance of the new Vitek 2 GP
card for identification of medically relevant gram-positive cocci in a routine
clinical laboratory. J. Clin. Microbiol. 43:84–88.
4. Stackebrandt, E., C. Koch, O. Gvozdiak, and P. Schumann. 1995. Taxonomic
dissection of the genus Micrococcus: Kocuria gen. nov., Nesterenkonia gen.
nov., Kytococcus gen. nov., Dermacoccus gen. nov., and Micrococcus cohn 1872
Downloaded from http://jcm.asm.org/ on May 25, 2018 by guest
gen. emend. Int. J. Syst. Bacteriol. 45:682–692.
5. Wauters, G., J. Charlier, M. Janssens, and M. Delmée. 2001. Brevibacterium
paucivorans sp. nov., from human clinical specimens. Int. J. Syst. Evol. Mi-
crobiol. 51:1703–1707.
Michael Boudewijns*
Jozef Vandeven
Jan Verhaegen
Department of Microbiology
University Hospital
Leuven, Belgium
*Phone: 32476857788
Fax: 3216347931
E-mail: m.boudewijns@erasmusmc.nl
Authors’ Reply
We thank Boudewijns et al. for their contribution. Their
rigorous evaluation of two strains from clinical specimens
shows conclusively that these isolates were correctly identified
as Kocuria kristinae by the Vitek 2 system with the new GP card
and database. It remains to be determined, however, whether
the new GP system will reduce the number of coagulase-neg-
ative staphylococci falsely identified as Kocuria spp. A rough
indication that the current test is not only sensitive but also
specific for Kocuria spp. might be the total number of isolates
identified as Kocuria at a certain laboratory. Given the rarity of
Kocuria spp. as human pathogens, one would expect an in-
crease in the specificity of the test to result in a substantial drop
in the number of Kocuria isolates identified. At our microbi-
ology laboratory, isolates from 21 patients were identified as
Kocuria spp. by the Vitek 2 system during the 6-month period
of March through August 2004. In the corresponding period of
2005, during which the new GP card was implemented, isolates
from only 6 patients were identified as Kocuria spp., suggesting
an improvement in the specificity of the Vitek 2 system.
The positive predictive value of the GP card is dependent on
the prevalence of true Kocuria isolates in the tested popula-
tion. Since such isolates are apparently rare, we maintain that
identification of Kocuria spp. by any array of phenotypic tests
is suspect and requires confirmation by genomic assays.
Ronen Ben-Ami
Yehuda Carmeli
Tel Aviv Sourasky Medical Center
Tel Aviv, Israel