Staphylococcus epidermidis biofilm causes device-related meningitis in neurosurgical patients. This study assessed the contribution of polysaccharide and protein to the development of a strong biofilm-positive phenotype in four S. epidermidis isolates associated with probable device-related meningitis, under varying environmental conditions. RT-PCR analysis of the intercellular adhesion operon (icaADBC) and assessment of polysaccharide intercellular adhesin (PIA) production indicated a correlation between increased icaA transcription and PIA production in ica + isolates grown in medium with 4 % ethanol and 4 % NaCl. Treatment of biofilm with sodium metaperiodate caused dispersion of adhered cells (P ,0.0001), indicating involvement of PIA. Transcriptional levels of protein factors revealed that atlE transcription levels were similar in all isolates, whilst aap levels were variable, with induction being seen in two isolates following growth in the presence of alcohol or salt. Transcription of agr did not influence protein expression and RNAIII transcription varied among the strains. Although aap transcription was induced, the treatment of biofilm with proteinase K did not always disperse the biofilm. Our data suggest that, among the three ica + S. epidermidis isolates clinically associated with meningitis that were studied, PIA contributed to the strong biofilm-positive phenotype, whereas protein factors appeared to have a secondary role.
INTRODUCTIONSuccessful treatment and prevention of hydrocephalus, a common neurosurgical condition, often involves the insertion of an external ventricular drain (EVD) or a shunt. However, this can be complicated by infections such as meningitis, often caused by coagulase-negative staphylococci (CoNS), with Staphylococcus epidermidis being isolated most frequently (Diaz-Mitoma et al., 1987). Mounting evidence suggests that such infections are a result of biofilm formation on the device (Diaz-Mitoma et al., 1987;Tojo et al., 1988;Kockro et al., 2000).Staphylococcal biofilm formation involves both host and bacterial factors. Early investigations have shown that production of polysaccharide is a primary mechanism employed by S. epidermidis (Peters et al., 1987;Tojo et al., 1988; Christensen et al., 1990;Mack et al., 1992). The polysaccharide is a polymeric homoglycan consisting of repeating units of b-1,6-N-acetylglucosamine (Mack et al., 1996; McKenney et al., 1998;Maira-Litran et al., 2002;Sadovskaya et al., 2005), termed polysaccharide intercellular adhesin (PIA). Synthesis of PIA is linked to the biosynthetic enzyme-coding genes located in the intercellular adhesion operon (icaADBC) (Heilmann et al., 1996), and biofilm production involving PIA is known to be ica-dependent and is considered the primary mechanism employed by staphylococci (Stevens et al., 2008).Other ica-independent mechanisms of biofilm development in staphylococci have been identified and protein factors such as the major cell-wall autolysin (AtlE) have been found to promote the initial adhesion of S. epiderm...