<xhtml:span xmlns:xhtml="http://www.w3.org/1999/xhtml" xml:lang="en">Bacterial skin infection caused by a plant pathogen Kosakonia cowanii - Identification with the&#160;MALDI Biotyper Sirius one and susceptibility testing </xhtml:span>

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Abstract

Kosakonia cowanii is a Gram-negative bacillus belonging to the order Enterobacterales. Kosakonia cowanii is a plant pathogen, we report the isolation of this organism from a gardening puncture injury from a plant. Pus examined from the site of infection showed the infecting organism as Kosakonia cowanii by MALDI-TOF MS Biotyper Sirius one and 16s rRNA analysis. The organism failed to be identified biochemically by the Vitek 2 XL identification system as Kosakonia spp.. The Gram-negative bacilli on the system was biochemically identified as Pantoea spp.. Difficulties in species identification biochemically suggests that potentially, Kosakonia cowanii might represent an underestimated opportunistic human pathogen in skin infections associated with plant injuries. The MALDI-TOF MS Biotyper Sirius one software was found to be a fast and reliable identification of the organism. The isolate was found to be susceptible to first generation cephalosporins, both to cefalexin and cefazolin by disc diffusion and Vitek 2 XL even though antibiotic breakpoints currently do not exist using EUCAST or CLSI guidelines for this organism.

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  1. Comments to Author

    This is a well-written and interesting paper, with the figure presentation done effectively and the paper organised in a logical manner that it easy to follow. Strengths: This is a rare pathogen, with only two previously described human cases. The paper highlights challenges in identifying rare pathogens using methodologies like biochemical reaction testing, though this is not entirely novel (e.g., the paper by Washio et al also misidentified it as Pantoea sp.). The inclusion of susceptibility results, including disc diameters and MICs from Vitek, is valuable and aligns with findings that this organism does not appear to harbour a chromosomal AmpC gene. Areas for Improvement: Clinical Information: The paper would benefit from more clinical details e.g., the patient's immune status (e.g., immunocompromised or not), severity of illness at presentation (e.g., bacteraemia, rhabdomyolysis), and clinical outcome. Treatment Details: Details on the treatment regimen (e.g., antibiotics and doses) and the patient's clinical response are needed. For example, prior reports noted failure with oral cephalexin, potentially due to subtherapeutic dosing. Such information would be valuable for clinicians managing similar cases. Overall Assessment: This paper is worth publishing; however, it would be significantly strengthened by including more clinical history, treatment details, and outcome data. These additions would enhance its value from a clinical perspective.

    Please rate the manuscript for methodological rigour

    Good

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  2. Comments to Author

    There are a few typographical errors: 16s is, by convention, written as 16S. In the paragraph entitled 'Bacterial culture', the colonies are described as 'weak non-lactose fermenters'. I presume this should read 'weak lactose fermenters'. In the paragraph entitled 'Bacterial Identification', the phrase '5 consecutive reading' should be '5 consecutive readings'. In the paragraph entitled '16S rRNA analysis', the phrase 'blast search' is usually written using capitalisation, as 'BLAST search'. In table 1 the units for MIC are written as mg/L^-1. Should this not be just mg/L? Tobramycin is misspelt as tobromycin. It would be helpful if the authors stated whether formic acid extraction was used prior to running the isolate through the MALDI-TOF. It would be helpful if the authors could include some basic details of the mechanism of infection. The discussion refers to penetrating injuries involving plant material, but the authors do not specifically report the nature of any injury or if there was any plant or soil contamination. Although ampC genes are chromosomally encoded on Enterobacter spp, this is classically confined to Enterobacter aerogenes & Enterobacter cloacae groups. In my experience Enterobacter/Pantoea agglomerans are not typically ampC producing. I think the last sentence of the discussion could be revised so as to better inform readers that the lack of ampC is an expected finding. It would also be helpful if the authors were to explicitly state if an ampC phenotypic test was negative. The clinical presentation of penetrating trauma involving plant material causing infections in immunocompetent individuals, especially children, has been well described as a cause of septic arthritis, endophthalmitis, wound infection, etc. Enterobacter/Pantoea agglomerans is one commonly cited organism in these cases. In most of these publications the identification of the organism was by VITEK or a similar biochemical methodology. Perhaps the authors could spend a couple of sentences speculating whether these publications might have been subject to misidentification of the organism. I would encourage the authors to submit their now well characterised isolate to a MALDI-TOF database to improve results for all users.

    Please rate the manuscript for methodological rigour

    Good

    Please rate the quality of the presentation and structure of the manuscript

    Satisfactory

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes