Clinical isolates that are difficult to identify by conventional means form a valuable source of novel human pathogens. We report on a 5-year study based on systematic 16S rRNA gene sequence analysis. We found 60 previously unknown 16S rRNA sequences corresponding to potentially novel bacterial taxa. For 30 of 60 isolates, clinical relevance was evaluated; 18 of the 30 isolates analyzed were considered to be associated with human disease.16S rRNA gene sequence analysis is broadly considered the "gold standard" in bacterial identification (6,29). In daily clinical diagnostics, accurate bacterial identification is essential in judging whether a bacterial isolate is to be considered the causative agent of an infectious disease or merely a colonizer. In our study, we aimed to characterize the bacterial diversity encountered in a diagnostic laboratory by revealing potentially novel, clinically relevant species, according to the current species definition by the Clinical and Laboratory Standards Institute (22).Routine 16S rRNA gene sequencing is implemented in our laboratory and is a fixed part of our diagnostic algorithms for identification of bacterial isolates (1, 2, 32). We retrospectively reanalyzed 16S rRNA gene sequences collected during 2004 to 2008 to identify potentially novel bacterial taxa of clinical relevance. The Institute of Medical Microbiology (IMM) serves the 850-bed University Hospital of Zurich and surrounding smaller hospitals. Bacterial isolates from blood, cerebrospinal fluid, wounds, joint aspirates, respiratory samples, genitourinary swabs, feces, and urine were recovered by culture on appropriate media according to standard procedures (19). Isolates that could not be identified by phenotypic methods underwent sequencing. 16S rRNA gene analysis was performed as previously described (1). Homology analyses were performed using the SmartGene Integrated Database Network System (IDNS) (24) and NCBI GenBank databases. For the first screening of our large data collection, we selected isolates with sequence homology of Ͻ99.0% to members of described taxa, regarding these as potentially novel species; isolates with sequence homology of Ͻ95% were regarded as representatives of a novel genus (2). The boundary for novel families was Ͻ87.5% homology and, for novel orders, Ͻ78.4% 16S rRNA sequence homology (30). After the first screening, we used more stringent cutoff values (Ͻ97.5% for species) for taxa with significant interspecies 16S rRNA divergence; i.e., members of the Paenibacillaceae family and the Clostridiales order (6, 25).During the 5-year study period, 1,663 cultured isolates were subjected to 16S rRNA gene sequence analysis (Table 1). Of those, 60 isolates (0.4‰; see Table S1 in the supplemental material) had a 16S rRNA gene homology of Ͻ99% to members of accepted taxa on the date of the first interpretation. A total of 11 of the 60 sequences with a 16S rRNA homology of Ͻ99% in the first-time analysis could be allocated to a species established during the study term as a novel species by othe...