Kosakonia radicincitans is a species within the new genus Kosakonia. Many strains of this genus have been isolated from plants, but some strains are assumed to act as facultative human pathogens. in this study, an in-depth analysis of a Kosakonia isolate from human blood was performed. the strain was originally isolated from blood and identified as a member of the Enterobacter cloacae complex, exhibiting an atypical result in susceptibility testing. therefore, the genetic background was examined, including phylogenetic classification and screening for virulence factors. Using whole-genome sequencing, the isolate was identified as a K. radicincitans strain, revealing a virulence gene cluster for yersiniabactin biosynthesis in contrast to all other strains of the species. Whole-genome sequencing was the perfect method for identifying putative virulence factors of a particular Kosakonia strain and will help distinguish beneficial strains from pathogenic strains in the future. To our knowledge, this is the first report of Kosakonia-related bacteraemia from europe. Kosakonia radicincitans is a species within the new genus Kosakonia, until recently part of the genus Enterobacter. Many Kosakonia species have been isolated from plants and are known to improve plant performance 1,2 , but there are also rare reports that assume that some Kosakonia spp., such as Kosakonia cowanii, can act as facultative human pathogens 3. There are also rare reports of Kosakonia radicincitans involved in human infections; however, all these reports are from outside Europe (mainly Asia and America). The first case of a human bloodstream infection with K. radicincitans was reported in a 61-year-old man with cholangiocarcinoma in Houston, Texas, USA, in December 2016 4. However, the actual number of infections could have been underestimated, as this genus is relatively new and is therefore probably not yet included in all automated databases of bacterial diagnostic tools. It seems that Kosakonia has no higher pathogenic or resistance properties than Enterobacter, making a more precise diagnosis unnecessary in many cases 4. Therefore, this study used the rare opportunity to diagnose such an infection by careful evaluation. The aim of the study was to analyse the genetic background of a Kosakonia isolate from a patient with bacteraemia, including phylogenetic classification and screening for virulence factors. Description of the case: An 85-year-old woman presented at the Department of Internal Medicine, in Graz, Austria, with icterus, occasionally diffuse abdominal pain and loss of appetite. Upon admission, she was afebrile, showed atrial flutter (3:1), and a heart rate of 100/min; she was in slightly poor general condition and had pressure pain in the middle and lower abdomen. Her liver values were significantly increased. She was diagnosed with bile duct stenosis and received a stent by endoscopic retrograde cholangiopancreatography (ERCP) on the third day
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