To further define the role offibrin(ogen) and fibronectin in Staphylococcus aureusadherence to central venous catheters, the amount, chemical integrity, and biologic activity of these proteins adsorbed on lines inserted in hospitalized patients were prospectively studied. Polyurethane cannulas promoted a significantly lower adherence of S. aureusthan polyvinyl chloride (P < .01) or Hickman (P < .001) cannulas and contained the lowest amount of immunologically assayed fibronectin but not offibrin(ogen). Fibrinogen showed an extensive loss of adherence-promoting activity on inserted cannulas, which was related to its proteolytic breakdown, as detected by SDS-PAGE and immunoblots with antifibrinogen antibodies and confirmed by in vitro studies with purified protein fragments. In contrast, either intact or fragmented fibronectin, although present in much lower amounts than fibrin(ogen), could actively promote S. aureus adherence onto intravenous catheters.Microbial colonization of intravascular devices is an important source of nosocomial infection and sepsis [1,2]. Such device-related infections are frequently due to staphylococci and represent a major risk to the patients receiving intravenous (iv) therapy [I, 2]. Several factors may explain the frequent colonization of iv devices by Staphylococcus aureus, Staphylococcus epidermidis, or other species ofcoagulase-negative staphylococci: First, the presence ofa transcutaneous cannula wound allowing skin microorganisms to migrate across the skin barrier [1,2]; second, the microbial production of mucoid exopolymeric substances enhancing the stickiness of colonizing organisms [3][4][5][6]; and third, the presence of plasma proteins adsorbed on iv devices, which might selectively promote staphylococcal attachment to their surfaces [7][8][9][10].We have reported that plasma proteins deposited on various categories of iv catheters removed from patients played a significant role in staphylococcal adherence [11]. Clinical isolates of S. aureus were more strongly promoted for adherence by cannula-adsorbed plasma proteins than clinical isolates of S. epidermidis [11]. This observation was explained in part by the more frequent occurrence ofclinical [8,12,13] 1993;167:633-41 of S. epidermidis on surface determinants recognizing some major plasma or matrix proteins, such as fibronectin [8,[10][11][12][14][15][16][17][18], fibrinogen [9,16,[19][20][21], collagen [13, 17], laminin [8, 17, 22], or vitronectin [23]. Each of these individual proteins is known to promote staphylococcal adherence when adsorbed in vitro on polymeric surfaces [8][9][10]. In our in vivo study, we also found that on cannulas inserted in patients, most of the adherence-promoting activity was mediated via surface-bound fibronectin and fibrinogen or fibrin [11]. However, the respective roles of each of these protein components in staphylococcal adherence could not be precisely evaluated [11].The objectives ofthis study were to quantify the respective content of surface-bound fibronectin versus fibrinoge...