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Aim: Recently, S. aureus small colony variants (SCVs) were reported to persist within cultured endothelial cells and to cause persistent and antibiotic resistant infections in humans. Because gentamicin can very reproducably select for electron transport deficient SCVs as shown in earlier in vitro experiments, we searched for SCVs in a patient with chronic osteomyelitis, who received gentamicin beads., Method: Special culture and identification procedures for determination of SCVs were used, including testing of the S. aureus specific nuc gene, pulsed field gel electrophoresis (PFGE) as a typing method and characterization of the auxotrophism of the SCVs., Results: In a case of a 34-year-old patient with chronic osteomyelitis who had previously been treated with gentamicin beads, menadione auxotrophic S. aureus SCVs as well as wild type S. aureus were recovered in multiple bone specimen. All different colony types isolated from simultaneous or from sequential specimen were shown to be clonal by PFGE., Conclusion: Recovery of S. aureus SCVs from a patient treated with gentamicin beads suggests that the slow release of gentamicin into the local environment may be an efficient way to select for and/or induce SCVs. These data should alert physicians to also consider SCVs when a treatment failure occurs in a patient that has received gentamicin beads.

Rabbits were immunized against staphylococcal nuclease by repeated intramuscular injections. After five weeks the peak of the antibody response was reached, after 17 weeks the titres are on the level of the starting point. Persons without staphylococcal infections showed titres between 1:200 and 1:300 (titre of normal). In patients with proved staphylococcal infection the peak of the titres is reached three month post infection. The level of the titre is influenced by the site of infection; deep infections gave higher values than superficial processes. The method of the AStaN-reaction was examined with respect of their reproducibility, clearness, specificity and diagnostic relevance. In proved staphylococcal infections the AStaN-reaction is more often positive than the AStaL-reaction.