Intravascular catheters are prone to staphylococcal infections. To study the role in staphylococcal adherence played by fibrinogen or fibrin and fibronectin deposited on inserted catheters, 187 peripheral or central cannulae were prospectively removed from hospitalized patients. Compared with uninserted catheters, which allowed only minimal adherence, previously inserted catheters promoted significant adherence of staphylococcal isolates from patients with intravenous device infections. Adhesion-promoting properties were studied with laboratory strains having well-defined affinities for either fibronectin or fibrinogen:· adherence of Staphylococcus aureus Cowan I, which has the highest affinity for both adhesins, was more strongly promoted (10-to 50-fold) on inserted cannulae than was that of S. aureus Wood 46 (4-to lO-fold) or Staphylococcus epidermidis Rp 12 (2.2-fold), which has no affinity for fibrinogen but does for fibronectin. Although all types of cannulae contained significant amounts of fibrin, which may promote adherence of coagulase-positive staphylococci, results obtained with coagulase-negative isolates suggested that in vivo-deposited fibronectin is also a critical determinant in this process.Infectious complications associated with the use of intravascular (iv) catheters have been reported to occur in 1070-40070 of cases [1][2][3]; these devices are important causes of nosocomial sepsis (1,(3)(4)(5) and candidemia [3,5]. A major contributing factor in iv device-related infection is the transcutaneous cannula wound allowing microorganisms from the patient's skin flora to migrate across the skin barrier. The microbial colonization of the transcutaneous part of the catheter has been identified as a sensitive index of catheter-associated bacteremia [6]. The establishment of a fibrin sheath [1] surrounding the blood-exposed cannula may favor bacterial attachment and promote bacterial replication around the intravascular part of the catheter. The thrombogenicity of plastic materials plays a role in their associ- ation with device-related infections [7]; the risks of phlebitis increase with duration of insertion and severity of underlying diseases [8]. Finally, impaired host mechanisms secondary to the presence of foreign implants might playa role in catheter-associated infections as for other implants [9].Intravenous catheters are most often colonized by staphylococci [6,[10][11][12]. Staphylococcus aureus was initially considered the predominant species in cannula-related septicemia, and Staphylococcus epidermidis has recently been identified as a major pathogen of these infections [13,14]. A number of studies [15][16][17][18][19][20][21][22][23][24] have shown that most coagulasenegative strains of staphylococci infecting intravascular lines produce an extracellular fibrous matrix, designated either as slime [15][16][17][19][20][21][22] or glycocalix [18,23,24]. This material is assumed to help coagulase-negative staphylococci colonize the indwelling devices [15][16][17][18][19][20][21][22][23][24][2...