Protective role of complement in experimental Escherichia coli endocarditis.

Fourteen strains of Escherichia coli were tested for ability to cause infective endocarditis in rabbits prepared by prior placement of an intracardiac catheter. Strains that were resistant to the bactericidal action of serum caused E. coli endocarditis in 91.4% of rabbits, whereas serum-sensitive strains usually failed to cause persisting infection (11.3% infected, P less than 0.001). Although serum-sensitive E. coli lodged on heart valves within 1 h after intravenous injection, they survived less than 24 h in most normal rabbits. In contrast to normals, all five C6-deficient rabbits injected with a serum-sensitive strain of E. coli developed infective endocarditis (P less than 0.005). No correlation was found between the presence of K1 antigen and the incidence of experimental E. coli endocarditis. Thus, the ability of strains of E. coli to establish persisting endocardial infection in rabbits appears to be directly associated with resistance to the complement-mediated serum bactericidal system. These findings may explain in part the rarity of gram-negative bacillary endocarditis in patients; they also indicate that in certain special circumstances the serum bactericidal system can play a decisive role in host defense.