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(Circulation. 1995;92:2715-2722.)
© 1995 American Heart Association, Inc.

Articles

The Pathogenic Role of Staphylococcus epidermidis Capsular Polysaccharide/Adhesin in a Low-Inoculum Rabbit Model of Prosthetic Valve Endocarditis

Hiroyuki Shiro, MD; Gloria Meluleni, MA; Andreas Groll, MD; Eugene Muller, PhD; Tor D. Tosteson, ScD; Donald A. Goldmann, MD; Gerald B. Pier, PhD

From Channing Laboratory, Department of Medicine, Brigham and Women's Hospital (H.S., G.M., A.G., E.M., G.B.P.) and the Division of Infectious Diseases and Bacteriology Laboratory, Department of Pediatrics, Children's Hospital (D.A.G.), Harvard Medical School, Boston, Mass; and the Department of Community and Family Medicine, Dartmouth Medical School (T.D.T.), Hanover, NH.

Correspondence to Dr Gerald B. Pier, Channing Laboratory, 180 Longwood Ave, Boston, MA 02115-5899. E-mail gpier@warren.med.harvard.edu.

Background The capsular polysaccharide/adhesin (PS/A) antigen of Staphylococcus epidermidis was required to produce endocarditis in a rabbit model in which infection resulted from hematogenous spread of bacteria from a contaminated catheter in the jugular vein. However, many prosthetic valve endocarditis (PVE) infections probably result from direct contamination of the valve with small numbers of bacteria during surgery. The role of PS/A in this situation was evaluated by modifying a rabbit model of endocarditis to partially mimic PVE.

Methods and Results A Teflon catheter was contaminated with graded inocula of either PS/A-positive S epidermidis strain M187sp11 or the PS/A-negative, isogenic strain M187sn3 and inserted into the left ventricle through the aortic valve. The PS/A-positive strain had a 50% infectious dose of 1.1x10² cfu (95% CI, 3.3 to 3.7x10³) compared with 8.5x10⁴ cfu of the PS/A-negative strain (95% CI, 8.6x10³ to 8.5x10⁵). The odds for developing endocarditis were estimated to be 42 times higher for any given inoculum level of the PS/A-positive strain (P=.1). When the PS/A-positive strain was adherent to a catheter surface it survived in rabbit blood, whereas under the same conditions the PS/A-negative strain was killed 90% in 1 hour.

Conclusions Direct contamination of an intraventricular foreign body by low levels of PS/A-positive S epidermidis results in endocarditis in rabbits, but at suitably high doses PS/A-negative strains have sufficient virulence to infect cardiac vegetations. PS/A enhances but is not absolutely required for bacterial virulence in a rabbit model of PVE.

Key Words: valves • prosthesis • endocarditis

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