Search

Intestinal colonization by Klebsiella, Enterobacter, and Serratia (KES) strains is a crucial step in the development of nosocomial infections. We studied the adhesive properties, antibiotic resistance, and involvement in colonization or infection of 103 KES clinical isolates: 30 Klebsiella pneumoniae (29%), 16 Klebsiella oxytoca (15%), 30 Enterobacter aerogenes (29%), 14 Enterobacter cloacae (14%), and 13 Serratia sp. (13%) isolates. Half of them were resistant to several antimicrobial agents, including aminoglycosides and beta-lactam antibiotics. A total of 27 of 30 K. pneumoniae isolates (90%) adhered to the human cell line Intestine-407 (Int-407), while none of the K. oxytoca or E. aerogenes isolates and only 2 of the E. cloacae isolates adhered. Three adhesive patterns were observed for K. pneumoniae: an aggregative adhesion in 57% of the isolates, a diffuse adhesion in only one isolate, and a new pattern, localized adhesion, in 30% of the isolates. While most of the sensitive strains adhered with the aggregative phenotype, the localized pattern was associated with resistant K. pneumoniae isolates producing the CAZ-5 beta-lactamase. Furthermore, 45% of such localized-adhesion isolates were involved in severe infections. The distributions of type 1 and type 3 fimbriae, enteroaggregative E. coli, and cf29, pap, and afa/Dr adhesin-encoding genes were determined by using specific DNA probes. No relationship was found between the adhesive pattern and the production of specific fimbriae, suggesting that several unrecognized adhesive factors are involved. Our study indicates that special adhesive properties associated with resistance to antimicrobial agents could account for the pathogenicity of certain nosocomial strains.

Salmonella typhimurium and enteropathogenic Escherichia coli (EPEC) were found to adhere to the brush border of differentiated human intestinal epithelial Caco-2 cells in culture, whereas Yersinia pseudotuberculosis and Listeria monocytogenes adhered to the periphery of undifferentiated Caco-2 cells. All these enterovirulent strains invaded the Caco-2 cells. Using a heat-killed human Lactobacillus acidophilus (strain LB) which strongly adheres both to undifferentiated and differentiated Caco-2 cells, we have studied inhibition of cell association with and invasion within Caco-2 cells by enterovirulent bacteria. Living and heat-killed Lactobacillus acidophilus strain LB inhibited both cell association and invasion of Caco-2 cells by enterovirulent bacteria in a concentration-dependent manner. The mechanism of inhibition of both adhesion and invasion appears to be due to steric hindrance of human enterocytic pathogen receptors by whole-cell lactobacilli rather than to a specific blockade of receptors.

Small bowel biopsy specimens were taken from 21 patients undergoing gastrointestinal endoscopy to detect a possible adhesion of bacteria to the mucous layer of the upper gastrointestinal tract. In 30 control biopsy specimens taken from 10 patients free from gastrointestinal pathology, no associated bacteria were found, whereas in 23 biopsy specimens taken from eight gastrectomized patients an associated bacterial flora including E. coli or Pseudomonas was grown. Bacterial adhesion was confirmed by means of transmission electron microscopy of the eight patients yielding positive cultures. Bacterial adhesion induced local alterations of the brush border membrane. These results suggest that adherent bacteria may be present in hypochlorhydric patients. Pathophysiologic consequences require further studies.

Bacteria adhere to almost any surface via specific surface molecules of recognition through which a firm union is established for successful colonization of the host. Studies have shown that adhesion plays an important and critical early role in the pathogenesis of infectious diseases, and a series of adhesins have been well documented in a certain number of strains and species of bacteria of medical importance. Attempts have been made to interfere with, or prevent adhesion of, harmful bacteria to the host tissue, using receptor analogues or bacterial adhesin-vaccines as prophylactic measures to protect recipients from specific bacterial diseases. Although much success has been reported from such procedures in laboratory animals and livestock, extensive clinical trials are required to assess the efficacy of such procedures in humans. However, reports from limited studies have shown some encouraging results. Future studies must also be directed to the isolation and characterization of more adhesins and receptors and their specific interactions, which would provide fuller understanding of mechanisms of bacterial adhesion, especially at molecular level.

Deletions within the cloned genes (fimA) encoding the type 1 major fimbrial subunits of two isolates of Klebsiella pneumoniae resulted in a nonfimbriate but hemagglutinating phenotype after transformation of Escherichia coli HB101 or ORN103. Phenotypic expression of type 1 fimbriae could be restored by transformation with plasmids containing the fimA genes of the fimbrial gene clusters from different strains. The surface fimbriae expressed were serologically identical to those of the polymerized product of the introduced fimA gene. The fimA gene products of Salmonella typhimurium and Serratia marcescens could utilize the accessory fimbrial genes of K. pneumoniae to produce surface-associated, hemagglutinating fimbriae. The relatedness of the type 1 fimbrial gene clusters from multiple isolates of members of the family Enterobacteriaceae was examined by DNA hybridization techniques. These analyses demonstrated little nucleotide sequence agreement among distinct genera of the enteric bacteria.