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Characterization of Tn917 insertion mutants of Staphylococcus epidermidis affected in biofilm formation.

Biofilm formation is thought to result from the concerted action of primary attachment to a specific surface and accumulation in multilayered cell clusters. Here we describe the isolation and characterization of transposon (Tn917) mutants of Staphylococcus epidermidis O-47 which were biofilm negative in the polystyrene microtiter plate assay. Among 5,000 Tn917 insertion mutants, 4 biofilm-negative mutants were isolated. Each mutant carried one copy of Tn917. The mutants were divided into two phenotypic classes: class A (mut1 and mut1a) and class B (mut2 and mut2a). Mutants of phenotypic class A lacked four cell surface proteins, were less hydrophobic, and were affected in primary attachment to polystyrene, but were still able to form multilayered cell clusters. They were able to form a biofilm on a glass surface, a trait that was even more pronounced than in the wild-type stain O-47. Loss of several surface proteins might have led to the reduced surface hydrophilic structures, thus favoring primary attachment to a glass surface and leading to subsequent biofilm formation. Mutants of phenotype class B were able to attach to polystyrene but were unable to form multilayered cell clusters, had unchanged cell surface proteins and hydrophobicity, and were unable to form a biofilm on a glass surface, mut1 and mut2 could be complemented by wild-type DNA fragments containing the Tn917 insertion sites of mut1 and mut2, respectively. The complemented biofilm-positive clone mut1 (pRC20) produced a 60-kDa protein which is postulated to function as the adhesin for binding to plastic. The traits of binding to polystyrene and the ability to form multilayered cell clusters are phenotypically and genetically distinct.

Animals↗

Source and route of methicillin-resistant Staphylococcus epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of special scrub suits.

The objective of this study was to trace the source and route of transmission of methicillin-resistant Staphylococcus epidermidis (MRSE) in the surgical wound during cardio-thoracic surgery, and to investigate the possibility of reducing wound contamination by wearing special scrub suits. In total 65 elective operations for coronary artery bypass grafting (CABG) with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves, and from patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Samples were also taken from the wound just before closure. Total counts of bacteria on sternal skin and from the wound (cfu/cm2) were calculated as well as total counts of bacteria in the air (cfu/m3). Strains of MRSE recovered from the different sampling sites were compared by pulsed field gel electrophoresis (PFGE). It was found that wearing special scrub suits did not reduce the number of air-samples where MRSE was found compared with conventional scrub suits. The risk factor most strongly associated with MRSE in the wound at the end of the operation was preoperative carriage of MRSE on sternal skin; RR 2.42 [95% CI 1.43-4.10], P= 0.021. By use of PFGE, it was possible to identify the probable source for four MRSE isolates recovered from the wound. In three cases the source was the patients own skin. Finding MRSE in air-samples, or on the hands of the scrubbed team, were not risk factors for the recovery of MRSE in the wound at the end of operation. In conclusion, with a total bacterial air count around 20 cfu/m3 and a low proportion of MRSE, the reduction of total air counts by use of tightly woven special scrub suits did not reduce air counts of MRSE or wound contamination with MRSE. The patients' sternal skin was the main source for wound contamination with MRSE

Adult↗

Very severe thrombocytopenia and fragmentation hemolysis mimicking thrombotic thrombocytopenic purpura associated with a giant intracardiac vegetation infected with Staphylococcus epidermidis: role of monocyte procoagulant activity induced by bacterial supernatant.

The pathogenesis of very severe thrombocytopenia in bacterial endocarditis is uncertain. We report a 50-year-old male with platelet counts < 10 x 10(9)/l and fragmentation hemolysis complicating Staphylococcus epidermidis pacemaker endocarditis with a giant vegetation. Antibiotics, corticosteroids, high-dose intravenous gammaglobulin, and plasmapheresis (for initially-suspected thrombotic thrombocytopenic purpura) failed to produce significant platelet count increase. However, therapeutic-dose heparin anticoagulation was associated with a platelet count increase from <10 to approximately 40 x 10(9)/l, with parallel reduction in thrombin-antithrombin complexes (from 8.9 to 3.5 microg/l), facilitating surgical intervention. The thrombocytopenia promptly resolved following surgical removal of the vegetation. Culture supernatant from S. epidermidis isolated from the patient's blood induced monocytes to express procoagulant activity (assessed by factor Xa generation) equivalent to lipopolysaccharide (1 microg/ml), with half-maximal activation seen with culture supernatant diluted to 1:12,800. These data are consistent with previous animal models of endocarditis demonstrating staphylococci-induced procoagulant changes in monocytes. This case demonstrates that heparin anticoagulation can be therapeutic in infective endocarditis-associated severe thrombocytopenia in a non-bleeding patient, and that such therapy may ameliorate the platelet count enough to permit surgical intervention.

Blood Coagulation↗

Effect of polyurethane catheters and bacterial biofilms on the in-vitro activity of antimicrobials against Staphylococcus epidermidis.

The effect of two polyurethane ['Cavafix Certo' (CAV); 'Viacath' (VIA)] catheters on the in-vitro activity of amikacin (AN), clindamycin (CM), cloxacillin (CX), ciprofloxacin (CIP), vancomycin (VA), teicoplanin (TEI) and daptomycin (DAP) against slime producing and non-producing Staphylococcus epidermidis strains was determined using a microdilution assay. None of the antimicrobial agents was significantly affected in the presence of the catheters. The susceptibility of S. epidermidis attached to CAV and VIA catheters was also evaluated. Minimum inhibitory concentration (MIC) values were similar when planktonic and attached bacteria were compared. Minimum bactericidal concentrations (MBCs) markedly increased in the presence of 6 and 48 h bacterial biofilms. These increases in MBC values occurred when either slime producing or non-producing strains were used, and in most cases were higher for CAV catheters than for VIA catheters. This phenomenon was shown not to be due to differences in bacterial adherence. It is concluded that the in-vitro bactericidal activity of certain antimicrobials markedly decreased when bacteria adhered to plastic catheters, but this effect could have been dependent partially on the nature of the catheters.

Anti-Bacterial Agents↗

Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants.

STUDY DESIGN: Bacterial adherence and biofilm formation in implant-associated infection may vary depending on species of microorganisms and characteristics of implant surfaces. OBJECTIVES: We evaluated the differences in adherence and biofilm formation between Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implant surfaces. SUMMARY OF BACKGROUND DATA: In implant-associated infections, bacteria in biofilm are resistant to antibiotics or host defense mechanism. The removal of implants is usually necessary to eradicate infection. On the contrary, in tuberculous infection, complete debridement and antituberculous chemotherapy without removal of implant have been regarded as a safe procedure. METHODS: S. epidermidis and M. tuberculosis were cultured with 4 types of metal segments, smooth or rough-surfaced stainless steel, and titanium alloy, respectively. After isolation of colonized microorganisms and biofilm with trypsin treatment and culture on plate media, colony-forming units were counted. The features of adherence and biofilm formation were observed under scanning electron microscopy. RESULTS: Biofilm-forming S. epidermidis showed heavy adhesion and multiplication on the surface of all 4 metal segments, 16.5 times more colony-forming units than nonbiofilm-forming ones. On scanning electron microscopy, there were many aggregated microcolonies with thick biofilm in biofilm-forming S. epidermidis but much less in nonbiofilm-forming S. epidermidis. M. tuberculosis were rarely adhered to metal surfaces and showed scanty biofilm formation. CONCLUSIONS: On the contrary to S. epidermidis, adherence and biofilm formation of M. tuberculosis on implant surface are less likely, and it can provide the basis of successful instrumentation in spine tuberculosis.

Alloys↗

In vivo efficacy of silver-coated fabric against Staphylococcus epidermidis.

BACKGROUND AND AIM OF THE STUDY: Prosthetic valve endocarditis (PVE) is a serious complication of heart valve replacement. The use of silver-coated polyester fabric in sewing cuff fabrication is intended to reduce the incidence of PVE. In this study, three pathogenic strains of Staphylococcus epidermidis (two PVE and one peripheral vasculature pathogen) were used to evaluate infection of silver-coated and uncoated fabric. METHODS: Fabric was inoculated by preincubation for 30 min in bacterial suspensions containing 10(4), 10(5), 10(6), 10(7) or 10(8) CFU/ml, and implanted subdermally in mice for up to seven days. Bacteria adherent to fabric implanted for zero, one, three, or seven days were enumerated by sonicating the fabric and plating serial dilutions of the resulting suspension. Percent infection was assessed by implanting samples, subdermally, for seven days, then incubating explanted samples in growth media for three days and calculating the percent of fabric showing bacterial growth, for each concentration of inoculum. A logistic regression model was used to estimate curves relating percent infection to log concentration of the bacterial inoculum. These curves were used to estimate the concentration of inoculum required to produce 50% infection (ID50) for the three strains of S. epidermidis, for silver-coated and uncoated fabric. RESULTS: Direct enumeration showed no difference in bacteria adherent to silver-coated and uncoated fabric, and no bacteria present in either fabric type in samples implanted for seven days. Nevertheless, incubation of those samples in growth media showed that many of the samples were infected. The calculated ID50 was significantly lower for silver-coated fabric than for uncoated fabric, for all three strains of S. epidermidis tested. CONCLUSION: Silver-coated fabric increases resistance to infection by S. epidermidis in this direct-contamination, mouse subdermal model.

Animals↗

Quantitative determination of catalase activity produced by Neisseria gonorrhoeae, Staphylococcus epidermidis, Neisseria meningitidis and other bacterial strains using the Catalasemeter.

The conventional catalase test only gives qualitative or semi-quantitative information of the amount of catalase activity produced. Using such a method, we have selected two strong catalase activity producers (Neisseria gonorrhoeae G-10, Staphylococcus epidermidis 66) and a weak producer (Neisseria meningitidis 34702). Quantitative determination of the catalase activity produced by these strains was done by the disk-flotation method using the Catalasemeter. The production of catalase activity in liquid culture by N. gonorrhoeae, S. epidermidis and N. meningitidis occurred mainly during the logarithmic growth phase. The maximum concentration of catalase activity found in these cultures was, for both strong producers, 160 units (U)/ml while it was around 20 U/ml for the weak producer. Some of the other bacteria tested showed high concentrations of catalase activity (130-162 U/ml) and these were: N. gonorrhoeae strain PR 77112 (penicillin resistant), Staphylococcus strain 7 (coagulase negative), Micrococcus sp. strains 2 and 42.

Bacteria↗

The bacterial peptide N-formyl-Met-Leu-Phe inhibits killing of Staphylococcus epidermidis by human neutrophils in fibrin gels.

To study human neutrophil (polymorphonuclear leukocyte (PMN)) migration and killing of bacteria in an environment similar to that found in inflamed tissues in vivo, we have used fibrin gels. Fibrin gels (1500 microm thick) containing Staphylococcus epidermidis were formed in Boyden-type chemotaxis chambers. PMN migrated < 300 microm into these gels in 6 h and did not kill S. epidermidis when the gels contained heat-inactivated serum, C5-deficient serum, a streptococcal peptidase specific for a fragment of cleaved C5 (C5a), or anti-C5aR IgG. In contrast, in gels containing normal human serum, PMN migrated approximately 1000 microm into the gels in 4 h and into the full thickness of the gels in 6 h, and killed 90% of S. epidermidis in 6 h. fMLP reduced PMN migration into fibrin gels and allowed S. epidermidis to increase by approximately 300% in 4 h, whereas leukotriene B(4) stimulated PMN to migrate the full thickness of the gels and to kill 80% of S. epidermidis in 4 h. We conclude that both complement opsonization and C5a-stimulated chemotaxis are required for PMN bacterial killing in fibrin gels, and that fMLP inhibits PMN bactericidal activity in fibrin gels. The latter finding is surprising and suggests that in the presence of fibrin fMLP promotes bacterial virulence.

Adhesins, Bacterial↗

Reliability of the ica, aap and atlE genes in the discrimination between invasive, colonizing and contaminant Staphylococcus epidermidis isolates in the diagnosis of catheter-related infections.

OBJECTIVES: To evaluate the usefulness of detecting two genes involved in biofilm formation (icaA and aap) and one gene involved in initial adhesion (atlE) for discrimination between contaminant, colonizing and invasive Staphylococcus epidermidis isolates involved in catheter-related infections. PATIENTS: The first group contained 29 isolates that were isolated from the skin of healthy volunteers (contaminant isolates). The second group contained 16 isolates recovered from catheters (>1000 CFUs on quantitative catheter culture) from asymptomatic patients without bacteremia. These isolates were considered to be colonizing isolates. The third group contained 34 isolates grown in >or=2 different blood cultures from patients with a systemic inflammatory response. These isolates were considered to be invasive isolates. RESULTS: The prevalence of atlE did not differ between the three groups. The icaA and aap genes were significantly more prevalent in colonizing isolates (88% aap; 88% icaA) than in invasive isolates (68% aap, P = 0.179; 59% icaA, P = 0.055) and than in skin isolates (52% aap, P = 0.02; 38% icaA, P = 0.002). CONCLUSIONS: The high prevalence of aap and icaA in skin isolates and their higher prevalence in colonizing than in invasive isolates led to a low specificity when these genes were used to differentiate between contamination, colonization and invasive infection. We conclude that, although the prevalence of these genes differs in the three groups, their presence cannot be used for clinical decision-making.

Bacteremia↗

Synergy of vancomycin plus cefazolin or cephalothin against methicillin-resistance Staphylococcus epidermidis.

The in vitro activity of cephalothin, cefazolin, and vancomycin against 25 isolates of methicillin-resistant Staphylococcus epidermidis was determined by means of a broth dilution technique with two sizes of inoculum. The size of the inoculum had a marked effect on the minimal inhibitory concentrations and the minimal bactericidal concentrations of all three antibiotics. With a small inoculum, 100% of the isolates were inhibited by 3.12 micrograms of vancomycin/ml, 76% by 12.5 micrograms of cephalothin/ml, and 64% by 12.5 micrograms of cefazolin/ml. With a large inoculum 100% of the isolates were inhibited by 200 micrograms of vancomycin/ml, 40% by 12.5 micrograms of cephalothin/ml, and 12% by 12.5 micrograms of cefazolin/ml. As determined by a tube dilution checkerboard technique for both sizes of inoculum, the combination of vancomycin plus cephalothin was synergistic against methicillin-resistant S. epidermidis in 45 of 50 cases, and the combination of vancomycin plus cefazolin was synergistic in 39 or 50 cases. These data from in vitro studies suggest that these antibiotic combinations should be evaluated clinically in patients with severe infections caused by methicillin-resistant S. epidermidis.

Cefazolin↗

Intra-abdominal abscess caused by Staphylococcus epidermidis.

An immunologically compromised patient was found to have a postoperative intra-abdominal abscess from which Staphylococcus epidermidis was the sole isolate. Studies of the isolate in a rabbit and in mice showed no evidence for unusual virulence of the organism. The S epidermidis probably was introduced into the peritoneal cavity during surgery and, because of the patient's neutropenia, produced a serious infection within a few weeks. To our knowledge, this is the first case of a intra-abdominal abscess associated with S epidermidis to be described in the literature.

Anti-Bacterial Agents↗

Growth of Staphylococcus epidermidis in anaesthetic resuscitative drugs: implications for potential contamination.

This controlled laboratory study investigated the survival of Staphylococcus epidermidis (S. epidermidis) over a 24 hour period in four commonly drawn-up anaesthetic resuscitative drugs: suxamethonium, atropine, metaraminol and ephedrine. These drugs were prepared in typical therapeutic concentrations and then inoculated with S. epidermidis. Samples of the inoculated drug preparations were cultured on horse blood agar plates at 0, 2, 6, 12 and 24 hourly intervals and incubated for 24 hours. Colony counts were performed at the end of the incubation period. Suxamethonium, atropine and metaraminol all showed an inhibitory effect on colony counts within the first six hours. There was a more gradual decline of colony counts over a 24 hour period in the ephedrine solution. This decline was similar to that occurring in the normal saline. It is concluded that suxamethonium, atropine and metaraminol do not support the survival of the common skin contaminant, S. epidermidis over a 24 hour period.

Adjuvants, Anesthesia↗

[Genetic structure of Staphylococcus epidermidis strain No. 17 possessing penicillinase and bacteriocinogenic activity].

The studies on the genetic structure of Staphylococcus epidermidis, strain 17 showed that this strain possessed a factor of bactericinogenicity of the one type, which was an extrachromosomal element not bound with penicillinase activity. The loss of the bacteriocinogenicity factor spontaneously or under the effect of acridine orange at a temperature of 37 degrees C was not observed. Passages of the strain at a temperature of 44 degrees C for 5 days and acridine orange proved to be the most effective eliminating factors. The loss of the bacteriocinogenicity plasmid did not result in changing any biochemical properties of the strain but was accompanied by a loss of the immunity to bacteriocin of the initial strain. The study of the growth regularities of the initial strain and its variant deprived of the bacteriocinogenicity plasmid showed that multiplication of the cells in the presence of the plasmid practically started without the latent period.

Acridine Orange↗

Initial adhesion and surface growth of Staphylococcus epidermidis and Pseudomonas aeruginosa on biomedical polymers.

The infection risk of biomaterials implants varies between different materials and is determined by an interplay of adhesion and surface growth of the infecting organisms. In this study, we compared initial adhesion and surface growth of Staphylococcus epidermidis HBH(2) 102 and Pseudomonas aeruginosa AK1 on poly(dimethylsiloxane), Teflon, polyethylene, polypropylene, polyurethane, poly(ethylene terephthalate), poly(methyl methacrylate), and glass. Initial adhesion was measured in situ in a parallel plate flow chamber with microorganisms suspended in phosphate-buffered saline, while subsequent surface growth was followed in full and in 20 times diluted growth medium. Initial adhesion of both bacterial strains was similar to all biomaterials. In full growth medium, generation times of surface growing S. epidermidis ranged from 17 to 38 min with no relation to wettability, while in diluted growth medium generation times increased from 44 to 98 min with increasing surface wettability. For P. aeruginosa no influence of surface wettability on generation times was observed, but generation times increased with decreasing desorption rates, maximal generation times being 47 min and minimal values down to 30 min. Generally, generation times of adhering bacteria were shorter than of planktonic bacteria. In conclusion, surface growth of initially adhering bacteria is influenced by biomaterials surface properties to a greater extent than initial adhesion.

Bacterial Adhesion↗

Biofilm testing of Staphylococcus epidermidis clinical isolates: low performance of vancomycin in relation to other antibiotics.

The in vitro killing effect of widely used antibiotics (cephalothin, clindamycin, erythromycin, ofloxacin, rifampicin, teicoplanin, tetracycline, phosphomycin and vancomycin) was comparatively analyzed in this study on 24-h biofilms of 64 Staphylococcus epidermidis clinical isolates. This effect was assessed at the expected antibiotic concentration reached in serum, using ATP-bioluminescence. Erythromycin, rifampicin, tetracycline and phosphomycin presented generally a higher killing effect than vancomycin, clindamycin, cephalothin, teicoplanin and ofloxacin in these biofilms. Differences in the resistance profiles obtained in classical assays (broth microdilution and diffusion) did not help to predict differences in the killing effect of the antibiotics in biofilms. Only some antibiotics (vancomycin but not rifampicin or tetracycline) highly decreased their killing effect as the biofilm age increased (from 6 to 24 or 48 h). These studies underline the relevance of biofilm susceptibility testing and the potential danger of the indiscriminate use of vancomycin monotherapy as the ultimate resource against infections involving aged biofilms.

Anti-Bacterial Agents↗

Ultrastructural organization and regulation of a biomaterial adhesin of Staphylococcus epidermidis.

Coagulase-negative staphylococci have emerged as important pathogens in infections associated with intravascular devices. Microbial adherence to biomaterial surfaces is a crucial step in the pathogenesis of these infections. Staphylococcal surface proteins (herein referred to as SSP-1 and SSP-2) are involved in the attachment of Staphylococcus epidermidis 354 to polystyrene. In the present study we show that the adhesin protrudes from the cell surface as a fimbria-like polymer. Furthermore, in vitro proteolytic cleavage of SSP-1 produces an SSP-2-like protein which coincides with a loss of adhesive function. SSP-1 expression is down-regulated in a phenotypical variant of S. epidermidis 354 whereas SSP-2 expression is not. These results could suggest that proteolytic cleavage is a key to the regulation of the adhesive state of S. epidermidis in vivo.

Adhesins, Bacterial↗

Polymerase chain reaction identification of coagulase-negative Staphylococci and of strain diversity and spread of Staphylococcus epidermidis in a major medical center in Lebanon.

A 2-step polymerase chain reaction (PCR) assay and random amplification of polymorphic DNA (RAPD) analysis, respectively, were assessed to identify coagulase-negative staphylococci organisms to the species level and to determine the strain diversity and spread of Staphylococcus epidermidis, the most frequently isolated species, in a medical center in Beirut, Lebanon. Our data indicated that PCR was faster and was more efficient in identifying S. epidermidis isolates than is conventional biochemical testing. RAPD analysis have shown that S. epidermidis strains were scattered across the different clinical services, demonstrating various clusters of infection in the medical center.

Base Sequence↗

Heparin and heparin-surface-modification reduce Staphylococcus epidermidis adhesion to intraocular lenses.

Bacterial adherence to intraocular lenses (IOLs) could be the cause of endophthalmitis following cataract surgery and lens implantation. The majority of cases of postoperative endophthalmitis are caused by microflora that reside on or near the eye of the patient. Staphylococcus epidermidis commonly colonizes the eyelid margin and conjunctiva and is the most common organism causing postoperative endophthalmitis. In this study, the in vitro adherence of S. epidermidis to regular poly-methyl methacrylate (PMMA) IOLs and to heparin-surface-modified (HSM) PMMA IOLs was investigated. The effects of heparin and antibiotics in solution on the adherence of bacteria to regular PMMA IOLs were evaluated. Adhesion of bacterial cells to IOLs was determined by counting the viable cells attached to the lenses. Significantly, fewer S. epidermidis attached to HSM-PMMA IOLs and to regular PMMA IOLs treated with heparin than to PMMA IOLs (p < 0.001). Furthermore, bacteria attached in significantly lower numbers to regular PMMA IOLs treated with heparin than to HSM-PMMA IOLs (p = 0.0031). Antibiotics in solution had no significant effect on bacterial adherence to PMMA IOLs. These data indicate that the use of HSM-PMMA IOLs and treatment of PMMA IOLs with heparin could diminish the incidence of postoperative endophthalmitis and intraocular inflammation associated with IOL implantation.

Anti-Bacterial Agents↗