“…Recent in vitro studies have provided evidence that PIA/PNAG is also required for immune evasion and virulence in S. epidermidis (Vuong et al, 2004). Although the majority of clinical S. aureus isolates contain the ica operon (Cramton et al, 1999;Arciola et al, 2001;Fowler et al, 2001;Frank et al, 2004;Rohde et al, 2004;Fitzpatrick et al, 2005), expression of the ica operon and biofilm production is tightly controlled under in vitro conditions (Ammendolia et al, 1999;McKenney et al, 1999;Cramton et al, 2001;Stepanovic et al, 2003;Fitzpatrick et al, 2005Fitzpatrick et al, , 2006 but is apparently upregulated in the in vivo infection milieu (McKenney et al, 1999;Fluckiger et al, 2005).…”