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Dear Editor, Kerstersia gyiorum is a pathogen that is infrequently reported in humans [1]. This bacterium, first classified in 2003, is a gramnegative coccobacillus belonging to the family Alcaligenaceae, which is isolated from water, soil, animal, and human specimens [2, 3]. Although some cases of K. gyiorum infection have been reported worldwide [4-8], none to date have been reported in Korea. We report the first case of chronic otitis media (COM) due to K. gyiorum infection in Korea. A 51-year-old female patient visited the otolaryngology department of Hanyang University Seoul Hospital with otorrhea in the left ear, which had started several weeks earlier. At the age of 25 and 28 years, she underwent canal wall-down mastoidectomies type III tympanoplasty of the right and left ears, respectively. On the day of admission, ear endoscopy revealed a purulent discharge and crust in the left external ear canal; therefore, the patient received crust removal and cefpodoxime treatment. A swab specimen was taken from the patient’s ear discharge and analyzed by bacterial culture and Gram staining. Gram staining revealed gram-negative coccobacilli in singles, pairs, and short chains (Fig. 1A). The specimen was inoculated on 5% sheep blood agar and MacConkey agar. After 24 hours, colonies of the organism grew on both sheep blood agar and MacConkey agar at 35°C under 5% CO2 (Fig. 1B and 1C). The colonies were gray and displayed spreading edges; colony isolates were oxidase negative and catalase positive. Isolates were examined using the MicroScan Walkaway (Beckman Coulter, Brea, CA, USA) and VITEK 2 (bioMérieux, Marcy-I’Etoile, France) automated bacterial identification systems; however, both analyses failed to identify the bacterial species. The species was identified as K. gyiorum by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) with a MALDI Biotyper using MALDI-Biotyper software (version 2.3, Bruker Daltonics, Bremen, Germany). 16S ribosomal RNA gene sequencing was performed using primers 27F (5 ́-AGAGTTTGATCCTGGCTCAG-3 ́) and 1492R (5 ́-GGTTACCTTGTTACGACTT-3 ́) as described previously [1]. We obtained a consensus sequence of 1,394 bp, which was 99.9% identical to K. gyiorum LMG 5906 (GenBank accession number AY131213). The next-nearest match was K. similis LMG 5890 (GenBank accession number AY131212), with 99.4% homology. In addition, gyrB gene sequencing was performed as described previously [4]. The gyrB gene sequence was 98.6% and 96.9% identical to K. gyiorum LMG 5906 (GenBank accession number HE585644) and K. similis LMG 5890 (GenBank accession number HE585647), respectively. The results of the antimicrobial susceptibility test performed with the MicroScan Walkaway system were assessed according to the Clinical and Laboratory Standards Institute (CLSI) minimum inhibitory concentration (MIC) standards for other non-

The First Case of Chronic Otitis Media due to Kerstersia gyiorum in Korea