Molecular aspects on pathogenesis of wound and foreign body infections due to staphylococci

Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices

Central venous device infections are associated with increased physical and psychological morbidity, mortality, length of stay, and costs. The aim of this study was to prove the efficacy of pulsatile flushing to prevent the bacterial colonization of vascular access devices. One hundred and forty four tests using 576 polyurethane short venous access catheters were performed. Four catheters per test were polluted with a fibronectin-serum albumin solution. Three were filled with a Staphylococcus aureus broth; one served as negative control. One contaminated catheter was not flushed (positive control), and two were flushed (10 mL.sec(-1)) with normal saline solution, either by ten successive boluses of 1 mL each or by one bolus of 10 mL. Each catheter was cultivated. The S. aureus quantity observed after continuous flushing was significantly higher than that observed after pulsative flushing (P<0.001). Unflushed catheters were 20.71 and 6.42 times more polluted than catheters flushed with the pulsative method or the continuous method, respectively. Pulsative flushing was at least twice as effective as continuous flushing in reducing the S. aureus count. Pulsative flushing is more effective than continuous flushing in reducing the endoluminal contamination. Pulsative flushing is a simple, effective, and inexpensive technique to reduce catheter bacterial colonization.

Mycobacterium ulcerans fails to infect through skin abrasions in a guinea pig infection model: implications for transmission

Transmission of M. ulcerans, the etiological agent of Buruli ulcer, from the environment to humans remains an enigma despite decades of research. Major transmission hypotheses propose 1) that M. ulcerans is acquired through an insect bite or 2) that bacteria enter an existing wound through exposure to a contaminated environment. In studies reported here, a guinea pig infection model was developed to determine whether Buruli ulcer could be produced through passive inoculation of M. ulcerans onto a superficial abrasion. The choice of an abrasion model was based on the fact that most bacterial pathogens infecting the skin are able to infect an open lesion, and that abrasions are extremely common in children. Our studies show that after a 90d infection period, an ulcer was present at intra-dermal injection sites of all seven animals infected, whereas topical application of M. ulcerans failed to establish an infection. Mycobacterium ulcerans was cultured from all injection sites whereas infected abrasion sites healed and were culture negative. A 14d experiment was conducted to determine how long organisms persisted after inoculation. Mycobacterium ulcerans was isolated from abrasions at one hour and 24 hours post infection, but cultures from later time points were negative. Abrasion sites were qPCR positive up to seven days post infection, but negative at later timepoints. In contrast, M. ulcerans DNA was detected at intra-dermal injection sites throughout the study. M. ulcerans was cultured from injection sites at each time point. These results suggest that injection of M. ulcerans into the skin greatly facilitates infection and lends support for the role of an invertebrate vector or other route of entry such as a puncture wound or deep laceration where bacteria would be contained within the lesion. Infection through passive inoculation into an existing abrasion appears a less likely route of entry.

Binding of heparan sulfate to Staphylococcus aureus

Heparan sulfate binds to proteins present on the surface of Staphylococcus aureus cells. Binding of 125I-heparan sulfate to S. aureus was time dependent, saturable, and influenced by pH and ionic strength, and cell-bound 125I-heparan sulfate was displaced by unlabelled heparan sulfate or heparin. Other glycosaminoglycans of comparable size (chondroitin sulfate and dermatan sulfate), highly glycosylated glycoprotein (hog gastric mucin), and some anionic polysaccharides (dextran sulfate and RNA) inhibited heparan sulfate binding to various extents. Heat treatment (80 degrees C for 10 min) and treatment of the bacteria with pronase E, proteinase K, pepsin, and chymotrypsin considerably reduced their ability to bind 125I-heparan sulfate, but treatment with trypsin and neuraminidase did not affect binding. Scatchard plot analysis indicated the presence of cell surface components with low affinity (Kd = 3 x 10(-5) M) for heparan sulfate. Cell surface components were released by stirring bacteria with 1 M LiCl at 37 degrees C for 2 h. Proteins of this extract that competitively inhibited binding of 125I-heparan sulfate to S. aureus were isolated by affinity chromatography on heparin-Sepharose. Two proteins having molecular masses of approximately 66 and 60 kDa and the ability to bind 125I-heparan sulfate were obtained. The first 9 amino-terminal amino acid residues of the 66-kDa protein are Asp-Trp-Thr-Gly-Trp-Leu-Ala-Ala-Ala, and the first 4 amino-terminal amino acid residues of the 60-kDa protein are Met-Leu-Val-Thr.

Bovine lactoferrin binding to six species of coagulase-negative staphylococci isolated from bovine intramammary infections

Bovine lactoferrin (BLf), an acute-phase iron-binding secretory protein present in secretions of the bovine udder, was demonstrated to bind to the following staphylococcal species associated with bovine intramammary infections: S. epidermidis, S. warneri, S. hominis, S. xylosus, S. hyicus, and S. chromogenes. The degree of 125I-labeled BLf uptake significantly varied among the blood agar-grown cells of all six species of coagulase-negative staphylococci tested. Isolates identified as S. xylosus demonstrated the highest (mean, 35.1 x 10(6) +/- 13.3 x 10(6) nmol) and S. hyicus the lowest (mean, 10.7 x 10(6) +/- 5.9 x 10(6) nmol) binding to 125I-BLf. BLf binding was optimum at an acidic pH, with time-dependent binding saturation ranging from 70 min for S. warneri to 240 min for S. hominis. The BLf-binding mechanism was specific, with affinity constants (Ka values) ranging between 0.96 x 10(6) and 11.90 x 10(6) liters/mol. The numbers of BLf-binding sites per cell, as determined by using Scatchard analysis, were as follows: S. epidermidis, 3,600; S. warneri, 1,900; S. hominis, 4,100; S. xylosus, 4,400; S. hyicus, 6,100; and S. chromogenes, 4,700. 125I-BLf binding to all species was inhibited by unlabled BLf and unlabeled human lactoferrin, whereas none of the various plasma, connective tissue, or mucosal secretory proteins or carbohydrates tested caused significant interference. BLf-binding receptors of the six coagulase-negative staphylococcal species demonstrated marked differences in patterns of susceptibility to proteolytic or glycolytic enzyme digestion and to heat or periodate treatment. These data suggest that the BLf-binding components in S. epidermidis and S. warneri are proteins containing glycosidyl residues. In the remaining four species, the proteinaceous nature of the BLf-binding component was evident, but the involvement of glycosidyl residues was not clear. Results of this study establish the presence of specific binding components for BLf on coagulase-negative staphylococci isolated from bovine intramammary infections.

Role of surface proteins in staphylococcal adherence to fibers in vitro

To study the role of surface proteins in the adherence of Staphylococcus aureus to fibers that are used in tampon and surgical gauze pad manufacture, we have developed an adherence assay with S. aureus cells and cotton and rayon fibers. Results suggest that staphylococcal adherence is dependent on both the substrate and the material used to coat these fibers. Scanning electron micrographs supported the adherence results and revealed more cells on the surface of cotton than rayon fibers. Treatment of staphylococcal cells with proteolytic enzymes significantly reduced binding to pure cotton and detergent-treated cotton fibers. Immunoblot analysis of cell wall proteins suggested that surface proteins in the mol wt range of 120-220 kD were involved in the adherence of S. aureus to cotton fibers. Although the adherence of S. aureus to cotton fibers alone appeared to be mediated through surface charge or hydrophobic interactions, bacterial binding to fibers which have been pretreated with defibrinated blood appeared to be more specific and independent of the surface constituents of the fibers. The results of these studies implicate staphylococcal surface proteins in the adherence of S. aureus to commercially available tampon fibers and surgical gauze pads.