title: The ica operon and biofilm production in coagulase-negative Staphylococci associated with carriage and disease in a neonatal intensive care unit.
abstract: Coagulase-negative staphylococci (CoNS) are a major cause of sepsis in the neonatal intensive care unit (NICU). We evaluated the hypothesis that the ica operon and biofilm production are associated with CoNS disease in this setting. CoNS associated with bacteremia or blood culture contamination and from the skin of infants with CoNS bacteremia or healthy controls were obtained during a prospective case-control study on a busy NICU. A total of 180 strains were identified, of which 122 (68%) were Staphylococcus epidermidis and the remainder were S. capitis (n = 29), S. haemolyticus (n = 11), S. hominis (n = 9), S. warneri (n = 8), and S. auricularis (n = 1). The presence of the genes icaA, icaB, icaC, and icaD was determined by PCR, and biofilm production was examined using qualitative (Congo red agar [CRA]) and quantitative (microtiter plate) techniques. There were no significant differences in the presence of the ica operon or CRA positivity among the four groups of strains. However, quantitative biofilm production was significantly greater in strains isolated from either the blood or the skin of neonates with S. epidermidis bacteremia. We conclude that the quantity of biofilm produced may be associated with the ability to cause CoNS infection. This conclusion suggests that the regulation of biofilm expression may play a central role in the disease process.
authors.affiliation: Nuffield Department of Clinical Laboratory Sciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
authors.forename: G D I
authors.initials: GD
authors.lastname: de Silva
authors.forename: M
authors.initials: M
authors.lastname: Kantzanou
authors.forename: A
authors.initials: A
authors.lastname: Justice
authors.forename: R C
authors.initials: RC
authors.lastname: Massey
authors.forename: A R
authors.initials: AR
authors.lastname: Wilkinson
authors.forename: N P J
authors.initials: NP
authors.lastname: Day
authors.forename: S J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D016470:Bacteremia / Q000382:microbiology; D018441:Biofilms / Q000254:growth & development*; D001769:Blood / Q000382:microbiology; D002353:Carrier State / Q000382:microbiology*; D016022:Case-Control Studies; D003030:Coagulase / Q000378:metabolism; D003470:Culture Media; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008826:Microbial Sensitivity Tests; D009876:Operon; D011135:Polysaccharides, Bacterial / Q000235:genetics*; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology; D013203:Staphylococcal Infections / Q000382:microbiology*; D013210:Staphylococcus / Q000145:classification / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification
chemical_list: D003030:Coagulase; D003470:Culture Media; D011135:Polysaccharides, Bacterial; C113579:polysaccharide intercellular adhesin