Host-bacteria interactions in foreign body infections

Deciphering the Antibacterial Role of Peptide From Bacillus subtilis subsp. spizizenii Ba49 Against Staphylococcus aureus

An increase in antibiotic resistance has led to escalating the need for the development of alternate therapy. Antimicrobial peptides (AMPs) are at the forefront of replacing conventional antibiotics, showing slower development of drug resistance, antibiofilm activity, and the ability to modulate the host immune response. The ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens that jeopardize most conventional antibiotics are known to be involved in severe respiratory tract, bloodstream, urinary tract, soft tissue, and skin infections. Among them, S. aureus is an insidious microbe and developed resistance against conventional antibiotics. In the present study, an AMP (named as peptide-Ba49) isolated from Bacillus subtilis subsp. spizizenii strain from Allium cepa (the common onion) exhibited strong antibacterial efficacy against S. aureus ATCC 25923. The mode of action of this peptide-Ba49 on S. aureus was deciphered through various sensitive probes, i.e., DiSC₃ (5) and H₂DCFDA, suggesting the peptide-Ba49 to be acting upon through change in membrane potential and by triggering the production of reactive oxygen species (ROS). This induced disruption of the cell membrane was further supported by morphological studies using scanning electron microscopy (SEM). Investigations on a possible post-antibiotic effect (PAE) of peptide-Ba49 showed prolonged PAE against S. aureus. Furthermore, the peptide-Ba49 prevented the formation of S. aureus biofilm at low concentration and showed its potential to degrade the mature biofilm of S. aureus. The peptide-Ba49 also exhibited intracellular killing potential against S. aureus ATCC 25923 in the macrophage cells, and moreover, peptide-Ba49 was found to bolster the fibroblast cell migration in the scratch assay at low concentration, exhibiting a wound healing efficacy of this peptide. These studies demonstrated that peptide-Ba49 isolated from the strain B. subtilis subsp. spizizenii could be a therapeutic candidate to combat the pathogenic S. aureus infections.

Host-Targeted Therapeutics against Multidrug Resistant Intracellular Staphylococcus aureus

Staphylococcus aureus is a facultative intracellular pathogen that invades and replicates within many types of human cells. S. aureus has shown to rapidly overcome traditional antibiotherapy by developing multidrug resistance. Furthermore, intracellular S. aureus is protected from the last-resort antibiotics—vancomycin, daptomycin, and linezolid—as they are unable to achieve plasma concentrations sufficient for intracellular killing. Therefore, there is an urgent need to develop novel anti-infective therapies against S. aureus infections. Here, we review the current state of the field and highlight the exploitation of host-directed approaches as a promising strategy going forward.

Fibrinogen binding is affected by amino acid substitutions in C-terminal repeat region of fibronectin binding protein A

Fibronectin-binding protein A (FnBPA), a protein displayed on the outer surface of Staphylococcus aureus, has a structured A-domain that binds fibrinogen (Fg) and a disordered repeat-region that binds fibronectin (Fn). Amino acid substitutions in Fn-binding repeats (FnBRs) have previously been linked to cardiovascular infection in humans. Here we used microtiter and atomic force microscopy (AFM) to investigate adhesion by variants of full-length FnBPA covalently anchored in the outer cell wall of Lactococcus lactis, a Gram-positive surrogate that otherwise lacks adhesins to mammalian ligands. Fn adhesion increased in five of seven FnBPA variants under static conditions. The bond targeting Fn increased its strength with load under mechanical dissociation. Substitutions extended bond lifetime (1/k_off) up to 2.1 times for FnBPA-Fn. Weaker adhesion was observed for Fg in all FnBPA variants tested with microtiter. However, mechanical dissociation with AFM showed significantly increased tensile strength for Fg interacting with the E652D/H782Q variant. This is consistent with a force-induced mechanism and suggests that the dock, lock, and latch (DLL) mechanism is favored for Fg-binding under mechanical stress. Collectively, these experiments reveal that FnBPA exhibits bimodal, ligand-dependent adhesive behavior. Amino acid substitutions in the repeat-region of FnBPA impact binding to both ligands. This was unexpected for Fg since all variants have the same A-domain sequence, and the Fg-binding site is distant from the repeat region. This indicates that FnBRs may fold back on the A-domain in a way that impacts the DLL binding mechanism for Fg.

Staphylococcus aureus biofilms: recent developments in biofilm dispersal

Staphylococcus aureus is a major cause of nosocomial and community-acquired infections and represents a significant burden on the healthcare system. S. aureus attachment to medical implants and host tissue, and the establishment of a mature biofilm, play an important role in the persistence of chronic infections. The formation of a biofilm, and encasement of cells in a polymer-based matrix, decreases the susceptibility to antimicrobials and immune defenses, making these infections difficult to eradicate. During infection, dispersal of cells from the biofilm can result in spread to secondary sites and worsening of the infection. In this review, we discuss the current understanding of the pathways behind biofilm dispersal in S. aureus, with a focus on enzymatic and newly described broad-spectrum dispersal mechanisms. Additionally, we explore potential applications of dispersal in the treatment of biofilm-mediated infections.

Bacterial adherence to different meshes used in abdominal surgery

BACKGROUND

We studied the influence of morphology and type of material of abdominal wall prostheses in the avoidance of bacterial adhesion in acute and chronic mesh infections.

METHODS

Three different types of prostheses were compared: 1) High-density polypropylene monofilament mesh (PMM); 2) low-density PMM; and 3) prostheses composed of low-density polypropylene and a non-porous hydrophilic film (composite prostheses). Microbial adhesion tests were performed using reference strains of Staphylococcus aureus 15981, Staphylococcus epidermidis ATCC 35984, Mycobacterium abscessus DSM 44196, and Mycobacterium fortuitum ATCC 13756 using a protocol described previously.

RESULTS

Both Staphylococcus spp. and M. fortuitum strains showed lower adherence to PMM. Mycobacterium abscessus also exhibited lower adherence to composite prostheses. Both Mycobacterium spp. strains had lower adherence than Staphylococcus spp. strains for all materials except for low-density PMM. Mycobacterium fortuitum showed higher adherence to composite prostheses than M. abscessus, whereas the latter species had higher adherence to high-density PMM than M. fortuitum.

CONCLUSION

Depending on the type of bacteria, collagen-coated hydrophilic prostheses with a large surface increased bacterial adherence significantly. These differences should be taken into consideration when choosing a mesh graft, which limits infection in abdominal wall reconstruction.

Role of Klebsiella pneumoniae type 1 and type 3 fimbriae in colonizing silicone tubes implanted into the bladders of mice as a model of catheter-associated urinary tract infections

Catheter-associated urinary tract infections are biofilm-mediated infections that cause a significant economic and health burden in nosocomial environments. Using a newly developed murine model of this type of infection, we investigated the role of fimbriae in implant-associated urinary tract infections by the Gram-negative bacterium Klebsiella pneumoniae, which is a proficient biofilm former and a commonly isolated nosocomial pathogen. Studies have shown that type 1 and type 3 fimbriae are involved in attachment and biofilm formation in vitro, and these fimbrial types are suspected to be important virulence factors during infection. To test this hypothesis, the virulence of fimbrial mutants was assessed in independent challenges in which mouse bladders were inoculated with the wild type or a fimbrial mutant and in coinfection studies in which the wild type and fimbrial mutants were inoculated together to assess the results of a direct competition in the urinary tract. Using these experiments, we were able to show that both fimbrial types serve to enhance colonization and persistence. Additionally, a double mutant had an additive colonization defect under some conditions, indicating that both fimbrial types have unique roles in the attachment and persistence in the bladder and on the implant itself. All of these mutants were outcompeted by the wild type in coinfection experiments. Using these methods, we are able to show that type 1 and type 3 fimbriae are important colonization factors in the murine urinary tract when an implanted silicone tube is present.

Orthopedics and biofilm--what do we know? A review

Bacteria have been found to grow predominantly in biofilms. The initial stage includes the attachment of bacteria to the substratum. Bacterial growth and division then leads to the colonization of the surrounding area and the formation of the biofilm. The environment in a biofilm is not homogeneous; the bacteria in a multispecies biofilm are not randomly distributed, but rather are organized to best meet their needs.

Although there is an initial understanding on the mechanisms of biofilm-associated antimicrobial resistance, this topic is still under investigation. A variety of approaches are being explored to overcome biofilm-associated antimicrobial resistance. A greater understanding of biofilm processes should lead to novel, effective control strategies for biofilm control and a resulting improvement in patient management.

[Inhibition of Staphylococcus epidermidis adhesion on titanium surface with bioactive water-soluble copolymers bearing sulfonate, phosphate or carboxylate functions]

Implanted prostheses are sometimes subject to bacterial infections, which can threat their benefit rule on a long-term basis. Various methods are studied to fight against these infections. Among them, the grafting of bioactive polymers onto the prosthesis surface shows up as a promising way to the problem of infections. This work presents the influence of various water-soluble bioactive polymers on the inhibition of the Staphylococcus epidermidis adhesion on the titanium samples surfaces initially preadsorbed with various proteins. Whatever the studied protein is, it is shown that the bioactive polymer containing sulfonate functions generates an inhibition of the adhesion of Staphylococcus epidermidis. For a plasma preadsorption, the inhibition rate rises up to 68% when the concentration of sulfonate function is 2.5μmol/L. Titanium surfaces grafted with the bioactive polymer were also tested. We find an inhibitive activity of the adhesion close to that of the previous case. These preliminary results can point up a clinical interest in the fight against the medical devices infection, because they highlight a clear local effect of S. epidermidis adhesion inhibition. Copolymers containing other functional groups (phosphate or carboxylate) were dissolved in a bacterial suspension to monitor the influence of the composition on the adhesion inhibition. Their inhibition rates are not significantly lower than those of pNaSS homopolymers, as much as the sulfonate function proportion remains higher than 50%. Thus, the sulfonate function is the main responsible for the inhibition of the S. epidermidis adhesion.

Poly(3-hydroxybutyrate) multifunctional composite scaffolds for tissue engineering applications

Poly(3-hydroxybutyrate) (P(3HB)) foams exhibiting highly interconnected porosity (85% porosity) were prepared using a unique combination of solvent casting and particulate leaching techniques by employing commercially available sugar cubes as porogen. Bioactive glass (BG) particles of 45S5 Bioglass grade were introduced in the scaffold microstructure, both in micrometer ((m-BG), <5 microm) and nanometer ((n-BG), 30 nm) sizes. The in vitro bioactivity of the P(3HB)/BG foams was confirmed within 10 days of immersion in simulated body fluid and the foams showed high level of protein adsorption. The foams interconnected porous microstructure proved to be suitable for MG-63 osteoblast cell attachment and proliferation. The foams implanted in rats as subcutaneous implants resulted in a non-toxic and foreign body response after one week of implantation. In addition to showing bioactivity and biocompatibility, the P(3HB)/BG composite foams also exhibited bactericidal properties, which was tested on the growth of Staphylococcus aureus. An attempt was made at developing multifunctional scaffolds by incorporating, in addition to BG, selected concentrations of Vitamin E or/and carbon nanotubes. P(3HB) scaffolds with multifunctionalities (viz. bactericidal, bioactive, electrically conductive, antioxidative behaviour) were thus produced, which paves the way for next generation of advanced scaffolds for bone tissue engineering.

Biofilm-forming associated genotypic and phenotypic characteristics of Staphylococcus spp. isolated from animals and air

Biological monitoring is performed to detect and analyze microorganisms that have continuously made an effort to survive in the environment. Of such microorganisms, Staphylococcus spp. is considered a common cause of nosocomial and environmental infections., Microbial Surface Components Recognizing Adhesive Matrix Molecules (MSCRAMMs) are required for the adhesion and biofilm formation of Staphylococci. Thirty-six and thirty-five Staphylococci isolated from animals and air, respectively, were analyzed. Biofilm formation and ten MSCRAMM genes were investigated using Congo red agar, tissue culture plate methods, and PCR. Airborne isolates were shown to have higher adherence and stronger biofilm formation than those from animals. The prevalence of MSCRAMM genes from air isolates was also higher than those from animals. Of the genes, eno was mainly associated with biofilm formation in both animals and airborne isolates (P<0.05). Moreover, the rate of airborne isolates harboring the eno gene was higher than in animal isolates. These results indicated that analysis of MSCRAMM genes with a phenotypic assay might be a helpful bacterial control system for the environment.

Staphylococci and implant surfaces: a review

Surfaces of internal fracture fixation implants are generally designed to encourage soft- and/or hard-tissue adherence, eventually leading to tissue or osseo integration. Unfortunately, this feature may also encourage bacterial adhesion. About half of the two million cases of nosocomial infections per year in the US are associated with indwelling devices. In the UK, implant-associated infections are estimated to cost pound 7-11 million per year, and with the rise in antibiotic-resistant bacteria, are an important issue. Soft-tissue infections and osteomyelitis are serious complications associated with implants, particularly open fractures, external fixation devices, and intramedullary nailing. Consequences of implant-associated infections include prolonged hospitalization with systemic antibiotic therapy, several revision procedures, possible amputation, and even death. This review discusses the issue of implant-associated infections and some of the methods used to prevent bacterial adhesion to osteosynthesis implants.

The significance of infection related to orthopedic devices and issues of antibiotic resistance

Over the last 15 years, with the advent of modern standards in the control of sterility within the operating room environment and adequate protocols of peri-operative antibiotic prophylaxis, the incidence of infections associated to orthopedic implants has become very low. Nevertheless, the event of infection still represents one of the most serious and devastating complications which may involve prosthetic devices. It leads to complex revision procedures and, often, to the failure of the implant and the need for its complete removal. In orthopedics, for the enormous number of surgical procedures involving invasive implant materials, even if nowadays rare, infections have a huge impact in terms of morbidity, mortality, and medical costs. The difficult battle to prevent and fight bacterial infections associated to prosthetic materials must be played on different grounds. A winning strategy requires a clear view of the pathogenesis and the epidemiology of implant-related infections, with a special attention on the alarming phenomenon of antibiotic resistance. In this regard staphylococci are the prevalent and most important causative pathogens involved in orthopedic implant-related infections, and, thus, the main enemy to defeat. In this paper, we offer an overview of the complexity of this battleground and of the current and new, in our opinion most promising, strategies in the field of biomaterials to reduce the risks and counteract the establishment of implant infections.

Detection of icaA and icaD loci by polymerase chain reaction and biofilm formation by Staphylococcus epidermidis isolated from dialysate and needles in a dialysis unit

Staphylococcus epidermidis, a coagulase-negative staphylococcus, is a major cause of infections associated with indwelling medical devices. Certain strains produce slime and form biofilm on polymer surfaces, where their pathogenicity is associated with biofilm formation. In this report, we investigated the presence or absence of the intercellular adhesion icaA and icaD genes by polymerase chain reaction, and phenotypic biofilm production was examined by qualitative Congo red agar (CRA) assay. A total of 32 strains of S. epidermidis were identified from dialysates and needles 4h after the initiation of dialysis. Qualitative biofilm production revealed that 16 (50%) strains produced slime on CRA plates. Among the 23 strains positive for the ica operon, 15 were biofilm positive on CRA, eight were biofilm negative, and one was icaA and icaD negative but produced slime. These results show that the ability of S. epidermidis to produce slime is not associated with the presence of icaA and icaD genes.

Staphylococcus aureus adhesion to titanium oxide surfaces coated with non-functionalized and peptide-functionalized poly(L-lysine)-grafted-poly(ethylene glycol) copolymers

Implanted biomaterials are coated immediately with host plasma constituents, including extracellular matrix (ECM); this reaction may be undesirable in some cases. Poly(L-lysine)-grafted-poly(ethylene glycol) (PLL-g-PEG) has been shown to spontaneously adsorb from aqueous solution onto metal oxide surfaces, effectively reducing the degree of non-specific adsorption of blood and ECM proteins, and decreasing the adhesion of fibroblastic and osteoblastic cells to the coated surfaces. Cell adhesion through specific peptide-integrin receptors could be restored on surfaces coated with PLL-g-PEG functionalized with peptides of the RGD (Arg-Asp-Gly) type. To date, no study has examined the effect of surface modifications by PLL-g-PEG-based polymers on bacterial adhesion. The ability of Staphylococcus aureus to adhere to the ECM and plasma proteins deposited on biomaterials is a significant factor in the pathogenesis of medical-device-related infections. This study describes methods for visualizing and quantifying the adhesion of S. aureus to smooth and rough (chemically etched) titanium surfaces without and with monomolecular coatings of PLL-g-PEG, PLL-g-PEG/PEG-RGD and PLL-g-PEG/PEG-RDG. The different surfaces were exposed to S. aureus cultures for 1-24h and bacteria surface density was evaluated using scanning electron microscopy and fluorescence microscopy. Coating titanium surfaces with any of the three types of copolymers significantly decreased the adhesion of S. aureus to the surfaces by 89-93% for PLL-g-PEG, and 69% for PLL-g-PEG/PEG-RGD. Therefore, surfaces coated with PLL-g-PEG/PEG-RGD have the ability to attach cells such as fibroblasts and osteoblasts while showing reduced S. aureus adhesion, resulting in a selective biointeraction pattern that may be useful for applications in the area of osteosynthesis, orthopaedic and dental implantology.

Catheter materials affect the incidence of late blood-borne catheter infection

BACKGROUND

Adherence of bacteria and subsequent catheter-related infections (CRI) are greatly enhanced by the fibrin sheath that develops on indwelling catheters. Since the infection rate of catheters without fibrin sheaths is low and the fibrin sheath mediates bacterial adherence, catheter material is not thought to affect the incidence of late catheter-related infection.

METHODS

A total of 276 rats had catheters placed in the right jugular vein with the proximal end buried subcutaneously to eliminate exit site infection. Rats were divided into two groups: silastic catheters (SC; n = 133) and polyurethane catheters (PC; n = 143). Injections of 1 x 10(8) CFU/mL of Staphylococcus epidermidis were given via the tail vein on either the day of surgery, day 0 (n = 53 SC, n = 51 PC), or on postoperative day 10 (n = 50 SC, n = 62 PC). Thirty animals from each group (SC, PC) received sterile saline injections on day 10 and served as controls. Animals were sacrificed on postinjection day 3. Catheters were removed via the chest and placed into trypticase soy broth. Broth was incubated at 37 degrees C for 48 h. Microscopy for the fibrin sheath was done on 20 randomly selected catheters (10/group). Data were compared using Fisher's exact test, with p < 0.05 considered significant.

RESULTS

Incidence of CRI was equal prior to the formation of the fibrin sheath, while CRI was significantly higher in silastic catheters in the presence of a fibrin sheath. Without a fibrin sheath (day 0), 8/53 silastic catheters and 3/51 polyurethane catheters were infected (p = NS). With a fibrin sheath (day 10), 31/50 silastic catheters were infected versus 20/62 polyurethane catheters (p < 0.05). Control catheters were all culture negative (30/group). With light microscopy, 20/20 catheters had fibrin sheaths at day 10 with no visible difference between silastic and polyurethane catheters.

CONCLUSION

Catheter material does affect the incidence of catheter-related infection even when catheters are coated with a fibrin sheath. This difference may relate to a difference in the fibrin sheath itself as it forms on different catheter materials.

GST-Fbe can recognize beta-chains of fibrin(ogen) on explanted materials

Staphylococcus epidermidis, a coagulase-negative staphylococcus (CoNS), is one of the leading pathogens of nosocomial infections, particularly associated with foreign body infections. Adherence of S. epidermidis to fibrinogen deposited on the surfaces of implants is important for the development of foreign body infections. A gene (fbe) encoding a fibrinogen-binding protein from S. epidermidis (Fbe) was identified by shotgun phage display. A portion of fbe was cloned into a GST-fusion vector. Affinity to glutathione-Sepharose by the GST-tag and affinity to fibrinogen-Sepharose by the Fbe part were applied to purify the recombinant Fbe. The purity and efficacy of the methods used in protein purification was compared. Furthermore, the potential physiological role of Fbe was studied by the interaction between GST-Fbe and components extracted from explanted materials in vitro.

Spotlight on naturally absorbable osteofixation devices

The practice of using implants is growing day by day, and more foreign materials are being inserted for various indications. The field of implantology thus deserves intensive research and careful evaluation of results. Solutions to overcome current problems and risks are necessary. It has taken a long time to arrive at where we are now. Bioabsorbable devices were explored in the 1960s for surgical bone fixation. Failures were followed by changes in ways of thinking and innovations. Improvements in the strength properties and biocompatibility were achieved. Bioabsorbable polymeric materials such as high-molecular-weight polymers were used and also reinforced with other material or, more recently, by self-reinforcement to produce small yet strong devices. New generations of implants include those that contain bioactive substances such as antibiotics and growth factors. Developments in bioabsorbable materials continue to accommodate the new way of thinking brought about by the emergence of the field of tissue engineering. Surgeons, conversely, are also inventing new surgical techniques and methods to exploit the plastic and bioabsorbability properties of these materials for the better future of our patients. Such a multidisciplinary approach that involves surgeons and materials scientists should help to find solutions to the current limitations of these devices.

Insertional inactivation of Eap in Staphylococcus aureus strain Newman confers reduced staphylococcal binding to fibroblasts

To initiate invasive infection, Staphylococcus aureus must adhere to host substrates, such as the extracellular matrix or eukaryotic cells, by virtue of different surface proteins (adhesins). Recently, we identified a 60-kDa cell-secreted extracellular adherence protein (Eap) of S. aureus strain Newman with broad-spectrum binding characteristics (M. Palma, A. Haggar, and J. I. Flock, J. Bacteriol. 181:2840-2845, 1999), and we have molecularly confirmed Eap to be an analogue of the previously identified major histocompatibility complex class II analog protein (Map) (M. Hussain, K. Becker, C. von Eiff, G. Peter, and M. Herrmann, Clin. Diagn. Lab. Immunol. 8:1281-1286, 2001). Previous analyses of the Eap/Map function performed with purified protein did not allow dissection of its precise role in the complex situation of the staphylococcal whole cell presenting several secreted and wall-bound adhesins. Therefore, the role of Eap was investigated by constructing a stable eap::ermB deletion in strain Newman and by complementation of the mutant. Patterns of extracted cell surface proteins analyzed both by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and by Western ligand assays with various adhesive matrix molecules clearly confirmed the absence of Eap in the mutant. However, binding and adhesion tests using whole staphylococcal cells demonstrated that both the parent and mutant strains bound equally well to fibronectin- and fibrinogen-coated surfaces, possibly due to their recognition by other staphylococcal adhesins. Furthermore, Eap mediated staphylococcal agglutination of both wild-type and mutant cells. In contrast, the mutant adhered to a significantly lesser extent to cultured fibroblasts (P < 0.001) than did the wild type, while adherence was restorable upon complementation. Furthermore, adherence to both epithelial cells (P < 0.05) and fibroblasts (not significant) could be blocked with antibodies against Eap, whereas preimmune serum was not active. In conclusion, Eap may contribute to pathogenicity by promoting adhesion of whole staphylococcal cells to complex eukaryotic substrates.

Effects on antibiotic resistance of Staphylococcus epidermidis following adhesion to polymethylmethacrylate and to silicone surfaces

A number of studies appears to give emphasis to the role of prosthetic materials in determining microbial adherence and resistance to host defence and drug therapy. Aim of this study was to explore whether the direct contact with biomaterial substrata of different chemical nature could influence bacterial behaviour, determining possible changes in the bacteria population as far as antibiotic resistance is concerned. To this end, susceptibility to penicillin, erythromycin, clindamycin, cefamandole, imipenem, vancomycin, ciprofloxacin. ampicillin, cefazolin, trimethoprim-sulfamethoxazole, chloramphenicol, amikacin and netilmicin was evaluated in a methicillin-, gentamicin- and tobramycin-resistant Staphylococcus epidermidis strain, after in vitro adhesion to polymethylmethacrylate (PM MA) and to silicone elastomer. The susceptibility to antibiotics of both adherent bacteria and bacteria which, although exposed to the materials, had not undergone adhesion was measured as bacterial growth inhibition area onto a plate antibiogram. according to Kirby-Bauer and using an image analyser system. The results obtained suggest that the two test materials considered in this study were capable to condition bacterial behaviour. In particular. the adhesion onto PMMA surfaces induced a marked and significant decrease in susceptibility to the following beta-lactam antibiotics: cefamandole (32%), cefazolin (23%), imipenem (27%), ampicillin (31%). Moreover, PMMA caused a lower but significant reduction in resistance to vancomycin (15%), chloramphenicol (16%), amikacin (13%). netilmicin (13%), erythromycin (11%) trimethoprim-sulfamethoxazole (13%). In contrast, the adhesion onto silicone elastomer appeared to influence bacterial changes to a lesser extent and elicited a significant decrease in susceptibility only to cefazolin (10%) and amikacin (11). Further studies are required to thoroughly investigate the mechanisms of these variations, even though, also according to other authors, one of the best conceivable conclusions is that some material substrata can lead to selection of variant adhesive bacteria with increased antibiotic resistance.

Identification and characterization of a novel 38.5-kilodalton cell surface protein of Staphylococcus aureus with extended-spectrum binding activity for extracellular matrix and plasma proteins

The ability to attach to host ligands is a well-established pathogenic factor in invasive Staphylococcus aureus disease. In addition to the family of adhesive proteins bound to the cell wall via the sortase A (srtA) mechanism, secreted proteins such as the fibrinogen-binding protein Efb, the extracellular adhesion protein Eap, or coagulase have been found to interact with various extracellular host molecules. Here we describe a novel protein, the extracellular matrix protein-binding protein (Emp) initially identified in Western ligand blots as a 40-kDa protein due to its broad-spectrum recognition of fibronectin, fibrinogen, collagen, and vitronectin. Emp is expressed in the stationary growth phase and is closely associated with the cell surface and yet is extractable by sodium dodecyl sulfate. The conferring gene emp (1,023 nucleotides) encodes a signal peptide of 26 amino acids and a mature protein of a calculated molecular mass of 35.5 kDa. Using PCR, emp was demonstrated in all 240 S. aureus isolates of a defined clinical strain collection as well as in 6 S. aureus laboratory strains, whereas it is lacking in all 10 S. epidermidis strains tested. Construction of an allelic replacement mutant (mEmp50) revealed the absence of Emp in mEmp50, a significantly decreased adhesion of mEmp50 to immobilized fibronectin and fibrinogen, and restoration of these characteristics upon complementation of mEmp50. Emp expression was also demonstrable upon heterologous complementation of S. carnosus. rEmp expressed in Escherichia coli interacted with fibronectin, fibrinogen, and vitronectin in surface plasmon resonance experiments at a K(d) of 21 nM, 91 nM, and 122 pM, respectively. In conclusion, the biologic characterization of Emp suggests that it is a member of the group of secreted S. aureus molecules that interact with an extended spectrum of host ligands and thereby contribute to S. aureus pathogenicity.

Reassessing the role of Staphylococcus aureus clumping factor and fibronectin-binding protein by expression in Lactococcus lactis

Since Staphylococcus aureus expresses multiple pathogenic factors, studying their individual roles in single-gene-knockout mutants is difficult. To circumvent this problem, S. aureus clumping factor A (clfA) and fibronectin-binding protein A (fnbA) genes were constitutively expressed in poorly pathogenic Lactococcus lactis using the recently described pOri23 vector. The recombinant organisms were tested in vitro for their adherence to immobilized fibrinogen and fibronectin and in vivo for their ability to infect rats with catheter-induced aortic vegetations. In vitro, both clfA and fnbA increased the adherence of lactococci to their specific ligands to a similar extent as the S. aureus gene donor. In vivo, the minimum inoculum size producing endocarditis in > or =80% of the rats (80% infective dose [ID80]) with the parent lactococcus was > or =10(7) CFU. In contrast, clfA-expressing and fnbA-expressing lactococci required only 10(5) CFU to infect the majority of the animals (P < 0.00005). This was comparable to the infectivities of classical endocarditis pathogens such as S. aureus and streptococci (ID80 = 10(4) to 10(5) CFU) in this model. The results confirmed the role of clfA in endovascular infection, but with a much higher degree of confidence than with single-gene-inactivated staphylococci. Moreover, they identified fnbA as a critical virulence factor of equivalent importance. This was in contrast to previous studies that produced controversial results regarding this very determinant. Taken together, the present observations suggest that if antiadhesin therapy were to be developed, at least both of the clfA and fnbA products should be blocked for the therapy to be effective.

Presence of icaA and icaD genes and slime production in a collection of staphylococcal strains from catheter-associated infections

Both Staphylococcus epidermidis and Staphylococcus aureus are important causes of infections associated with catheters and other medical devices. It has recently been shown that not only S. epidermidis but also S. aureus can produce slime and carries the ica operon responsible for slime production. In the operon, coexpression of icaA and icaD is required for full slime synthesis. In this study, the presence of icaA and icaD was determined in a collection of 91 staphylococcal (68 S. epidermidis and 23 S. aureus) strains from intravenous catheter-associated infections, in 10 strains from the skin and mucosa of healthy volunteers, and in two reference strains by a PCR method. Slime-forming ability was tested on Congo red agar plates; 49% of S. epidermidis strains from catheters and, surprisingly, 61% of S. aureus strains were icaA and icaD positive and slime forming. All the saprophytic strains turned out to be negative for both icaA and icaD and also non-slime forming. Two S. aureus and one S. epidermidis strain from catheters, detected as icaA and icaD positive by PCR analysis and as slime forming (black colonies) at 24 h on Congo red agar, at 48 h exhibited tiny red spikes at the center of black colonies. The onset of these variants could not be ascribed to a mutagenic potential of Congo red, which, in the Ames test, was devoid of mutagenicity. PCR analysis showed that these red variants were negative for both icaA and icaD and even lacking the entire icaADBC operon. The data reported indicate an important role of ica genes as a virulence marker in staphylococcal infections from intravenous catheters.

A rapid PCR method for the detection of slime-producing strains of Staphylococcus epidermidis and S. aureus in periprosthesis infections

In periprosthesis tissues, Staphylococcus epidermidis produces extracellular polysaccharide slime. Recently it has been shown that S. aureus also produces slime and that both S. epidermidis and S. aureus contain the ica operon responsible for slime production. In the operon, icaA encodes for N-acetylglutaminyltransferase, the enzyme for polysaccharide synthesis. However, co-expression of icaA and icaD is required for full slime synthesis. The slime-producing strains of both S. epidermidis and S. aureus are more virulent and are responsible for severe postsurgical or periprosthesis infections. The authors describe a simple, rapid, and reliable polymerase chain reaction method to detect icaA and icaD. The method was applied to the detection of ica genes on two reference strains, 15 strains each of S. epidermidis and S. aureus from periprosthesis infections and 10 strains from the skin and mucosa of healthy volunteers. icaA and icaD were detectable only in slime-producing strains (tested for slime production on Congo Red agar), and never in nonslime-producing ones. This method is a straightforward way of detecting the slime-producing ability by S. epidermidis and S. aureus. In clinical specimens this polymerase chain reaction method enables rapid diagnosis of virulent slime-producing strains with respect to the traditional culture method on Congo Red agar, which requires much more time. Rapid identification of the virulent properties of the bacterial strain responsible for a staphylococcal infection is crucial for deciding treatment.

Contribution of clumping factor B to pathogenesis of experimental endocarditis due to Staphylococcus aureus

Staphylococcus aureus Newman with an insertion mutation in clfB, the gene encoding clumping factor B, only marginally decreased infection rate (P>0.05) in rats with experimental endocarditis. In contrast, clfB complementation on a multicopy plasmid significantly increased infectivity (P<0.05) over the deleted mutants. Although clfB could affect endovascular infection, its importance in experimental endocarditis was limited.

Deletion of the alternative sigma factor sigmaB in Staphylococcus aureus reveals its function as a global regulator of virulence genes

A deletion of the sigB operon was constructed in three genetically distinct Staphylococcus aureus strains, and the phenotypes of the resulting mutants were analyzed. Compared to the corresponding wild-type strains, the DeltasigB mutants showed reduced pigmentation, accelerated sedimentation, and increased sensitivity to hydrogen peroxide during the stationary growth phase. A cytoplasmic protein missing in the DeltasigB mutants was identified as alkaline shock protein 23, and an extracellular protein excreted at higher levels in one of the DeltasigB mutants was identified as staphylococcal thermonuclease. Interestingly, most sigB deletion phenotypes were only seen in S. aureus COL and Newman and not in 8325, which was found to contain an 11-bp deletion in the regulator gene rsbU. Taken together, our results show that sigmaB is a global regulator which modulates the expression of several virulence factors in S. aureus and that laboratory strain 8325 is a sigmaB-defective mutant.