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A 140-kilodalton extracellular protein is essential for the accumulation of Staphylococcus epidermidis strains on surfaces.

Two distinct pathogenic mechanisms, adhesion to polymer surfaces and subsequent accumulation of sessile bacterial cells, are considered important pathogenic steps in foreign body infections caused by Staphylococcus epidermidis. By using mitomycin mutagenesis, we have recently generated a mutant, strain M7, from S. epidermidis RP62A which is unaffected in adhesion but deficient in accumulation on glass or polystyrene surfaces and lacks a 115-kDa extracellular protein (designated the 140-kDa antigen; F. Schumacher-Perdreau, C. Heilmann, G. Peters, F. Götz, and G. Pulverer, FEMS Microbiol. Lett. 117:71-78, 1994). To evaluate the role of this protein in accumulation, we harvested extracellular proteins from S. epidermidis RP62A grown on dialysis membranes placed over chemically defined medium, purified the protein by using ion-exchange chromatography, determined its N-terminal amino acid sequence, and raised antiserum in rabbits. The antibody recognized only a single band in a Western immunoblot of the crude extracellular extract. With the microtiter biofilm test, antiserum at a dilution of < or =1:1,000 blocked accumulation of RP62A up to 98% whereas preimmune serum did not. The 140-kDa antigen was found only in extracellular products from bacteria grown under sessile conditions. Of 58 coagulase-negative clinical isolates, 32 strains were 140-kDa antigen positive and produced significantly larger amounts of biofilm than the 26 strains that were 140-kDa antigen negative. The 140-kDa protein appears to be biochemically and functionally unrelated to any previously described factors associated with biofilm formation. Thus, the 140-kDa antigen, referred to as accumulation-associated protein, may be a factor essential in S. epidermidis accumulation and, due to its immunogenicity, may allow the development of novel immunotherapeutic strategies for prevention of foreign body infection.

Amino Acid Sequence↗

Intravitreal taurolidine against experimental Staphylococcus epidermidis endophthalmitis in rabbits.

PURPOSE: Taurolidine is a broad spectrum, non-antibiotic antimicrobial agent, not previously tested against infectious endophthalmitis. The efficacy of intravitreal taurolidine in the treatment of experimental Staphylococcus epidermidis endophthalmitis was evaluated and compared with vancomycin in a rabbit model. METHODS: The right eyes of 34 albino rabbits were infected with an intravitreal inoculum of S. epidermidis (10(5) colony-forming units/0.1 ml). The right eyes of four rabbits (group 7) were not infected and served as uninfected controls. 24 hours after inoculation of bacteria the animals were divided into the following treatment groups: group 1 (7 rabbits) received intravitreal taurolidine at 24 hours and group 2 (7 rabbits) received at 48 hours. Group 3 (7 rabbits) received vancomycin at 24 hours and group 4 (7 rabbits) at 48 hours. Group 5 (3 rabbits) received polyvinylpyrrolidone at 24 hours and group 6 (3 rabbits) at 48 hours. Clinical scoring was performed at 24, 48 and 72 hours. At 72 hours post inoculation, vitreous samples were collected for quantitative microbiological studies and then, the eyes were enucleated for histopathological scorings. RESULTS: The clinical and histopathological examinations revealed significant amelioration of inflammation in eyes treated with taurolidine and vancomycin when compared with polyvinylpyrrolidone. The eyes treated with taurolidine also had significantly lower colony forming units than the eyes treated with polyvinylpyrrolidone and taurolidine rendered many eyes sterile. CONCLUSION: Taurolidine is expected to be a potential agent for treatment of S. epidermidis endophthalmitis.

Animals↗

Adherence of Serratia marcescens, Serratia liquefaciens, Pseudomonas aeruginosa and Staphylococcus epidermidis to blood transfusion bags (CPD-SAGMAN sets).

The adherence of 4 isolates of Serratia marcescens, 1 isolate of Serratia liquefaciens, 1 of Pseudomonas aeruginosa, and 2 of Staphylococcus epidermidis to blood transfusion sets (CPD-SAGMAN) consisting of bags and connecting tubing was tested. All strains adhered well to the connecting tubes (polyvinyl chloride) from the transfusion sets from 3 manufacturers. Three isolates from a Swedish outbreak of septicaemia associated with contaminated blood bags showed greater adherence than an isolate from a urinary tract infection. There was no significant adherence of S. marcescens to the blood bags. In general, there were no significant differences in the adherence of a given isolate to the plastics from different manufacturers. Appropriate hygienic procedures for the production of transfusion sets appear to be of greater importance than differences in the plastic material as regards the incidence of transfusion-related bacteremia.

Bacteremia↗

Bactericidal effect of pulsed 1,064 nm Nd:YAG laser light on Staphylococcus epidermidis is of photothermal origin: an in vitro study.

BACKGROUND AND OBJECTIVE: The aim was to investigate the bactericidal effect of the 1,064 nm Nd:YAG laser on Staphylococcus epidermidis. MATERIAL AND METHODS: S. epidermidis was inoculated on agar plates and then exposed to pulsed laser light in three different modes: with an uninterrupted train of pulses, or with two different repeated cycles of fractionated trains of pulses. The agar temperature was measured directly after uninterrupted radiation. RESULTS: A bacterial growth inhibition area of 0.3 cm(2) and maximum temperature of approximately 80 degrees C was observed after uninterrupted radiation at 2,000 J cm(-2). The corresponding figures after an exposure of 5,000 J cm(-2) were 0.9 cm(2) and 100 degrees C, respectively. No bacterial inhibition was observed after exposure to repeated cycles of 20 seconds of radiation followed by 60 seconds of rest. CONCLUSION: The antimicrobial effect of the 1,064 nm Nd:YAG laser light is caused by a photothermal rather than a photochemical effect.

Agar↗

Regulated expression of pathogen-associated molecular pattern molecules in Staphylococcus epidermidis: quorum-sensing determines pro-inflammatory capacity and production of phenol-soluble modulins.

Phenol-soluble modulin (PSM) is a peptide complex produced by the nosocomial pathogen Staphylococcus epidermidis that has a strong capacity to activate the human innate immune response. We developed a novel method based on liquid chromatography-mass spectrometry (LC-MS) to quantify the production of the individual PSM components. Each PSM peptide was abundant in most of the 76 S epidermidis strains tested. Importantly, none of the PSM components were secreted by an agr mutant strain, indicating that PSM synthesis is regulated strictly by the agr quorum-sensing system. Furthermore, the agr mutant strain failed to elicit production of TNFalpha by human myeloid cells and induced significantly less neutrophil chemotaxis compared with the wild-type strain. Thus, quorum-sensing in S. epidermidis dramatically influenced activation of human host defence. We propose that an agr quorum-sensing mechanism facilitates growth and survival in infected hosts by adapting production of the pro-inflammatory PSMs to the stage of infection.

Bacterial Toxins↗

Using bacteriophages to reduce formation of catheter-associated biofilms by Staphylococcus epidermidis.

Use of indwelling catheters is often compromised as a result of biofilm formation. This study investigated if hydrogel-coated catheters pretreated with a coagulase-negative bacteriophage would reduce Staphylococcus epidermidis biofilm formation. Biofilms were developed on hydrogel-coated silicone catheters installed in a modified drip flow reactor. Catheter segments were pretreated with the lytic S. epidermidis bacteriophage 456 by exposing the catheter lumen to a 10-log-PFU/ml culture of the bacteriophage for 1 h at 37 degrees C prior to biofilm formation. The untreated mean biofilm cell count was 7.01+/-0.47 log CFU/cm2 of catheter. Bacteriophage treatment with and without supplemental divalent cations resulted in log-CFU/cm2 reductions of 4.47 (P<0.0001) and 2.34 (P=0.001), respectively. Divalent cation supplementation without bacteriophage treatment provided a 0.67-log-CFU/cm2 reduction (P=0.053). Treatment of hydrogel-coated silicone catheters with an S. epidermidis bacteriophage in an in vitro model system significantly reduced viable biofilm formation by S. epidermidis over a 24-h exposure period, suggesting the potential of bacteriophage for mitigating biofilm formation on indwelling catheters and reducing the incidence of catheter-related infections.

Biofilms↗

Effect of vancomycin hydrochloride on Staphylococcus epidermidis biofilm associated with silicone elastomer.

Peritonitis is a major complication of continuous ambulatory peritoneal dialysis. Relapsing peritonitis after the cessation of antimicrobial therapy is frequently reported and often involves Staphylococcus epidermidis. To investigate the potential role of catheter-associated biofilm in the pathogenesis of relapsing peritonitis, we describe an in vitro model permitting the development of an S. epidermidis biofilm on silicone elastomer biomaterial. This model has been used to investigate the ability of vancomycin hydrochloride to kill biofilm-encased organisms by using an antibiotic regimen typical of peritonitis therapy. No significant differences were seen between vancomycin-exposed and control groups in biofilm viable and total cell counts after 10 days. Vancomycin-exposed silicone-associated biofilm populations decreased by only 0.5 log10 CFU/cm2 over the study period. MICs and MBCs for the original S. epidermidis suspension were 3.125 and 6.25 micrograms/ml, respectively. For biofilm homogenate suspensions, MICs were 3.125 micrograms/ml, but MBCs were greater than 400 micrograms/ml. These data indicate that the biofilm organisms associated with an indwelling peritoneal catheter may display a form of tolerance, thereby suggesting one possible mechanism behind relapsing peritonitis.

Humans↗

Evaluation of clinical and laboratory findings in leukaemic patients with blood cultures positive for Staphylococcus epidermidis.

It is not certain whether clinical or laboratory findings help to distinguish true bacteraemia from contamination among acute leukaemic patients with one or more blood cultures positive for Staphylococcus epidermidis. We studied 31 patients treated at the Haematological Unit between 1 January, 1992 and 30 June, 1995 who were considered to have 'true bacteraemia', indicated by at least two positive blood cultures, and 20 considered to have probable 'contamination', indicated by a single positive culture. Fever at onset of positive blood culture, level of C-reactive protein (CRP) one day after the first positive blood culture and mortality did not differ between the groups. However, the median increase in CRP over 24 h from the first positive blood culture was significantly higher in true bacteraemias than among contaminants (median 35 mg/L vs 5 mg/L, P < 0.05). Patients with true bacteraemia were more likely than those with contaminants to have central catheters in situ (95 vs 75%, P < 0.05) and previous oral antibiotic prophylaxis (29 vs 5%, P < 0.05). Also clinical signs of catheter infection (30 vs 7%) were more common in true bacteraemias. In conclusion, central catheterization, antibiotic prophylaxis and clinical signs of catheter infection increase the likelihood of true bacteraemia; however, these factors have limited clinical utility in differentiation of true bacteraemia from contamination. Daily monitoring of serum CRP levels may help in the clinical decision-making.

Adolescent↗

Population analysis of susceptibility to methicillin, vancomycin, and three cephalosporines in two methicillin-resistant strains of Staphylococcus epidermidis.

Population analyses of susceptibility to methicillin, vancomycin, cephalothin, cefamandole, and cefoxitin were carried out with two strains of Staphylococcus epidermidis (S. epidermidis) resistant to penicillin, streptomycin, and methicillin. Two strains of Staphylococcus aureus (S. aureus), one sensitive to penicillin the other resistant, were used as controls. All strains were clinical isolates. From the strains of S. epidermidis it was possible to select sub-populations highly resistant to methicillin, cephalothin, cefamandole, and cefoxitin. The mutation-rate varied between c. 10(-3) and 10(-7). The two strains were homogeneous as regards vancomycin susceptibility. Methicillin was shown to be more penicillinase-stable than the cephalosporines. Treatment in vivo, with cephalothin and vancomycin did not increase the frequency of highly resistant bacteria against any of the antibiotics, but during treatment with cephalothin the majority-population became eight times more resistant to vancomycin and may explain why the treatment in vivo was not successful.

Cephalosporins↗

Correlation of biofilm expression types of Staphylococcus epidermidis with polysaccharide intercellular adhesin synthesis: evidence for involvement of icaADBC genotype-independent factors.

IcaADBC-encoded proteins mediate synthesis of the intercellular polysaccharide adhesin (PIA), which is essentially involved in Staphylococcus epidermidis biofilm formation. Seventy S. epidermidis isolates were investigated for their ability to form biofilm and synthesize PIA in different growth media including trypticase soy broth obtained from Becton Dickinson (TSBBBL), or Oxoid (TSB(OXOID)), and TSB(OXOID) supplemented with 0.5% N-acetylglucosamine, and for the presence of icaADBC. Dependent on the medium used (TSB(BBL) or TSB(OXOID)), the isolates exhibited a differential expression of PIA and biofilm formation, with 51 (72.85%) and 34 (48.57%) being biofilm positive, respectively. Using these growth media four different expression phenotypes were differentiated: similar quantities of biofilm formation in both TSBBBL and TSB(OXOID) (11 isolates, type A), significantly reduced biofilm expression in TSB(OXOID) compared to TSB(BBL) (23 isolates, type B), biofilm negative in TSB(OXOID) but biofilm producing in TSB(BBL) (17 isolates, type C) and biofilm negative in both media (19 isolates, type D). For all strains a biofilm-positive phenotype in a specific medium was closely linked to expression of PIA in that medium. All but one strain of expression type A-C and 7/19 expression type D strains were icaADBC positive. On the basis of restriction fragment length polymorphisms, the isolates were classified into two main icaADBC genotypes. There was no association between the observed biofilm-expression types and a defined icaADBC genotype. In the biofilm-negative S. epidermidis 5179, isolated from a ventriculo-atrial shunt infection, the insertion of IS257 interrupted the transcription of icaADBC, resulting in a PIA- and biofilm-negative phenotype. In all other icaADBC-positive, biofilm-negative isolates no major alterations of the icaADBC gene locus were identified. Obviously, expression of icaADBC, PIA synthesis and biofilm formation are integrated into a complex regulatory network involving other determinants independent of icaADBC genotype. Inactivation of icaADBC by IS elements is apparently a rare cause of a biofilm-negative phenotype in clinical S. epidermidis isolates.

Bacterial Proteins↗

An in vitro study of the properties influencing Staphylococcus epidermidis adhesion to prosthetic vascular graft materials.

This study examines the influence of the properties of various vascular graft materials on the bacterial adherence process of two different strains of Staphylococcus epidermidis (mucous and normucous producing). Dacron grafts (both knitted and woven), Teflon grafts, and Dacron grafts coated with one and two layers of silicone were studied because these materials differ significantly in porosity, hydrophobicity, and surface charge (zeta potential). Graft segments were immersed in 3H-labeled bacteria solution for periods ranging from 5 to 180 minutes and liquid scintillation techniques were used to quantify bacterial adherence. The porous knitted Dacron material had a significantly higher rate of bacterial adherence than either the woven Dacron or Teflon (p less than 0.05). Silicone coating (either one or two layers) reduced adherence by a factor of four for the knitted Dacron (p less than 0.05) and by a factor of two for woven Dacron (p less than 0.05). The mucous producing strain of S. epidermidis displayed significantly better adherence to woven and knitted Dacron than the normucous producing strain, but only when 0.25% dextrose was added to the bacteria solution. These findings indicate that the highly porous knitted Dacron grafts have the highest propensity for bacterial adhesion. Graft materials with the most negative zeta potentials are more resistant to bacterial adherence. Silicone coating of Dacron material significantly changed adherence characteristics, suggesting that this may be a viable strategy for protecting implantable medical devices containing materials to which bacteria readily adhere.

Adhesiveness↗

Staphylococcus epidermidis as a cause of postoperative wound infection after cardiac surgery: assessment of pathogenicity by a wound-scoring method.

Wound infection after clean surgery prolongs hospital stay but the organism most commonly isolated from wound discharge, Staphylococcus epidermidis, is often dismissed as a contaminant or commensal. The wounds of 517 patients were assessed, after cardiac surgery, by a wound-scoring method ('ASEPSIS') and a close comparison was made of the appearance and clinical outcome of 89 wounds, from which bacteria were isolated. There was no significant difference in the scores of 49 wounds, where S. epidermidis was the sole isolate (9.5 per cent of all wounds, 95 per cent CI 6.9-12.0 per cent), and 13 wounds infected with Staphylococcus aureus (2.5 per cent, 95 per cent CI 1.2-3.9 per cent). Repeat cultures were obtained from 21 of the 49 wounds and, in 16 of these, the second isolate showed the same biochemical reactions and antibiotic resistance pattern as the first. Infection of sternal wounds is commoner with coagulase-negative staphylococci than with S. aureus and, clinically, is just as severe.

Cardiac Surgical Procedures↗

Atrio-ventricular shuntinfections and endocarditis due to Staphylococcus epidermidis.

Two groups of patients (with endocarditis and with atrioventricular shunt infections due to Staphylococcus epidermidis) are presented together with analysis of the causative agents by bio- and phage-typing. Additionally phagocytic function of polymorphonuclear leukocytes of selected patients was investigated but no decreased phagocytic function was found. A possible way of treatment is discussed.

Cardiac Surgical Procedures↗

Decreased affinity of PBP3 to methicillin in a clinical isolate of Staphylococcus epidermidis with borderline resistance to methicillin and free of the mecA gene.

Analysis of the antibiotic binding capacity of penicillin-binding proteins (PBPs) in a group of clinical isolates of Staphylococcus epidermidis suggests that the increased level of resistance to methicillin (MIC 4.0 microg/ml) in an isolate free of the mecA gene is due to the decreased binding capacity of PBP3.

Bacterial Proteins↗

Endemic nosocomial transmission of Staphylococcus epidermidis bacteremia isolates in a neonatal intensive care unit over 10 years.

To assess long-term nosocomial transmission, trends in antibiotic resistance, and expression of potential virulence factors, 86 randomly selected Staphylococcus epidermidis bloodstream isolates obtained from 80 patients in a neonatal intensive care unit (NICU) over a 10-year period were studied. Pulsed-field gel electrophoresis (PFGE) analysis of SmaI-digested whole chromosomal DNA revealed distinctive banding patterns that persisted in the NICU over long periods. Pattern A included 22 isolates (26%) obtained during 1983-1990, and pattern B included 24 isolates (28%) from 1983 to 1991. All 10 isolates examined in 1984 fell into one of these two patterns. Isolates with either pattern expressed polysaccharide/adhesin (PSA) and slime; 90% and 87% were resistant to oxacillin and gentamicin, respectively, with no trends over time. These findings suggest that distinct clones of S. epidermidis can become endemic in NICUs over periods as long as a decade and that nosocomial transmission plays an important role in neonatal S. epidermidis bacteremia.

Bacteremia↗

PCR-based identification of Staphylococcus epidermidis targeting gseA encoding the glutamic-acid-specific protease.

The frequency of the gseA gene encoding a glutamic acid-specific serine protease, GluSE, of Staphylococcus epidermidis was investigated. DNA hybridization analysis demonstrated that gseA existed exclusively in S. epidermidis but not in other bacteria examined. A single step PCR assay with a set of designed primers yielded amplification of gseA from all 69 clinical isolates of S. epidermidis taken from patients and healthy adults, whereas production of GluSE was observed in 74% (51/69) of the isolates. Furthermore, none of the 46 clinical isolates of other species of coagulase-negative staphylococci and 45 clinical isolates of Staphylococcus aureus showed amplification, except a Staphylococcus capitis strain. However, this strain was positive for a S. epidermidis-specific DNA region and the DNA sequence of the 16S rRNA gene showed 99% identity with that of S. epidermidis. Therefore, these results indicated that the present PCR assay for gseA was ubiquitous and highly specific for detection of S. epidermidis.

Bacterial Proteins↗

Potentiation of Staphylococcus epidermidis catheter-related bacteremia by lipid infusions.

Lipid infusions given to low-birth-weight neonates are associated with coagulase-negative staphylococcal bacteremia. A rabbit model of catheter-related Staphylococcus epidermidis bacteremia was used to compare infection rates between animals receiving 20% lipid infusions with those receiving 10% glucose infusions. Bacterial growth was detected in 43 (66%) of 65 blood cultures obtained during lipid infusions but only 6 (7%) of 91 blood cultures obtained during glucose infusions (P < .001). S. epidermidis was cultured from 7 of 9 catheters recovered from lipid-infused rabbits but from only 3 of 13 catheters from glucose-infused rabbits (P = .016). Lipid but not glucose solutions containing low levels of protein (0.1%-1.0%) supported the survival and growth of S. epidermidis. These results suggest that lipids contribute to the survival and growth of S. epidermidis on contaminated catheters, enhancing the potential of these organisms to disseminate and cause bacteremia.

Animals↗

Apotransferrin administration prevents growth of Staphylococcus epidermidis in serum of stem cell transplant patients by binding of free iron.

We investigated the effect of free, non-transferrin-bound iron occurring in haematological stem cell transplant patients on growth of Staphylococcus epidermidis in serum in vitro, and prevention of bacterial growth by exogenous apotransferrin. S. epidermidis did not grow in normal serum at inoculated bacterial densities up to 10(3) cfu ml(-1) but slow growth could be detected at higher initial inocula. Addition of free iron abolished the growth-inhibitory effect of serum, whereas addition of apotransferrin again restored it. Appearance of free iron and loss of growth inhibition coincided in patient serum samples taken daily during myeloablative therapy. Intravenously administered apotransferrin effectively bound free iron and restored the growth inhibition in patient sera. The results suggest that exogenous apotransferrin might protect stem cell transplant patients against infections by S. epidermidis and possibly other opportunistic pathogens.

Apoproteins↗