Persistent staphylococcal infections are a major medical problem, especially when they occur on implanted materials or intravascular catheters. This review describes some of the recently discovered molecular mechanisms of Staphylococcus aureus attachment to host proteins coating biomedical implants. These interactions involve specific surface proteins, called bacterial adhesins, that recognize specific domains of host proteins deposited on indwelling devices, such as fibronectin, fibrinogen, or fibrin. Elucidation of molecular mechanisms of S aureus adhesion to the different host proteins may lead to the development of specific inhibitors blocking attachment of S aureus, which may decrease the risk of bacterial colonization of indwelling devices (Infect Control Hosp Epidemiol 1996;17:514-520).
INTRODUCTIONDespite the continuing development of potent antimicrobial agents, acute septic and chronic persistent infections due to Staphylococcus aureus 1 and coagulase-negative staphylococci (CNS) have increased in recent years. 2-4 Major infections due to S aureus are either non-devicerelated, such as surgical wound infections, or device-related. The clinical significance of CNS in human infections was recognized only in the past 2 decades. 2-4 This recognition was delayed by the fact that these organisms were found to be less virulent than S aureus in animal models of experimental infection and frequently were considered to be contaminants of blood cultures. Coagulase-negative staphylococci now are considered as the leading pathogens of indwelling catheter and prosthetic device infections, thus contributing to the majority of hospital-acquired bacteremias. 2-4Irrespective of their different virulence and persistence characteristics, over the last decades, both S aureus and CNS have accumulated multiple, unrelated resistance determinants. Methicillin-resistant strains of S aureus or Staphylococcus epidermidis, which frequently harbor several additional resistance determinants, represent a high risk for severely ill patients. Control of such infections requires expensive surveillance programs.