ASSOCIATION OF RESPIRATORY-TRACT COLONIZATION WITH ADHERENCE OF GRAM-NEGATIVE BACILLI TO EPITHELIAL-CELLS

Factors that promote oropharyngeal colonization of seriously ill patients with gram-negative bacilli are as yet poorly understood. In this investigation, 34 subjects who required intensive care were studied; 18 (53%) were colonized with gram-negative bacilli. Oropharyngeal epithelial cells of all colonized patients contained adherent bacilli. Fewer a-hemolytic streptococci but greater numbers of Pseudomonas aeruginosa and Klebsiella pneumoniae (P - 0.01) adhered in vitro to buccal epithelial cells from colonized patients than to cells from noncolonized patients. Adherence of bacilli to buccal cells was inhibited in vitro by concanavalin A but not by bovine serum albumin or phytohemagglutinin. Brief exposure of buccal cells to trypsin increased adherence of bacilli. Prior adherence of one species of bacilli inhibited subsequent adherence of a second species. These findings suggested that epithelial cells of the upper respiratory tract contain binding sites for gram-negative bacilli. Factors associated with serious illness appear to increase the availability of these binding sites, thus facilitating colonization of the upper respiratory tract with gram-negative bacilli. © 1979 by The University of Chicago.