Organisms in the genus Kocuria are Gram-positive, coagulase-negative, coccoid actinobacteria belonging to the family Micrococcaceae, suborder Micrococcineae, order Actinomycetales. Sporadic reports in the literature have dealt with infections by Kocuria species, mostly in compromised hosts with serious underlying conditions. Nonetheless, the number of infectious processes caused by such bacteria may be higher than currently believed, given that misidentification by phenotypic assays has presumably affected estimates of the prevalence over the years. As a further cause for concern, guidelines for therapy of illnesses involving Kocuria species are lacking, mostly due to the absence of established criteria for evaluating Kocuria replication or growth inhibition in the presence of antibiotics. Therefore, breakpoints for staphylococci have been widely used throughout the literature to try to understand this pathogen's behaviour under drug exposure; unfortunately, this has sometimes created confusion, thus higlighting the urgent need for specific interpretive criteria, along with a deeper investigation into the resistance determinants within this genus. We therefore review the published data on cultural, genotypic and clinical aspects of the genus Kocuria, aiming to shed some light on these emerging nosocomial pathogens.
IntroductionThe genus Kocuria was named after Miroslav Kocur, a Slovakian microbiologist, and belongs to the family Micrococcaceae, suborder Micrococcineae, order Actinomycetales, class Actinobacteria (Takarada et al., 2008;Zhou et al., 2008;Lee et al., 2009;Stackebrandt et al., 1995). It includes Gram-positive, strictly aerobic (a few exceptions are Kocuria kristinae, which is facultatively anaerobic, Kocuria marina, which may grow in 5 % CO 2 , and Kocuria rhizophila strain DC2201, which can proliferate anaerobically), catalasepositive, coagulase-negative, non-haemolytic cocci. These are also non-encapsulated, non-endospore-forming, non-halophilic, mesophilic, non-motile and Voges-Proskauer (production of indole and acetoin)-negative, and do not possess mycolic or teichoic acids. Kocuria species can be differentiated from other members of the Actinomycetales based on the presence of galactosamine and glucosamine as main cell wall amino sugars, the peptidoglycan type L-Lys-Ala 3/4 , the fatty acid anteisio-C 15 : 0 , the polar lipids diphosphatidylglycerol and phosphatidylglycerol, MK-7(H 2 ) and MK-8(H 2 ) as major menaquinones and a DNA G+C content of 60.0-75.3 mol%, depending on the species. Organisms in the genus are environmental bacteria, as well as human skin and oropharynx mucosa commensals; nevertheless, they can be responsible for infectious processes which mostly complicate severe underlying diseases. Owing to misidentification by phenotypic typing over the years, clinical syndromes caused by these agents are believed to be rare; however, the prevalence of such infectious pathologies is presumably higher and will surely increase in the coming years, as soon as genome-based identification i...