Diagnostic and therapeutic significance of staphylococcal teichoic acid antibodies.

Alpha- or beta-acetylglucosamine are major antigen determinants of ribitol teichoic acids of the cell walls of coagulase-positive staphylococci. Teichoic acid antibodies have been detected by quantitative immunoprecipitation methods, agar-gel diffusion, counterimmunoelectrophoresis, crossed immunoelectrophoresis, radioimmunoassay and enzyme-linked immunosorbent assay. Almost all adults have detectable antibodies if a sufficiently sensitive method is used. Elevated concentrations of teichoic acid antibodies result from a recent staphylococcal disease such as endocarditis, bacteremia with metastatic foci of abscesses in which drainage and/or antibiotic therapy is delayed, but increases in teichoic acid antibodies are infrequent in transient staphylococcal bacteremia such as from infected intravascular cannulae or abscesses in patients who are treated early. Detection of high concentrations of teichoic acid antibodies may allow a specific bacteriological diagnosis earlier than cultures, when cultures are negative as in partially treated endocarditis, and when cultures are difficult to obtain or evaluate such as deep seated abscesses, drainage from osteomyelitis or pneumonias. In addition, elevated concentrations of teichoic acid antibodies in patients with staphylococcal bacteremia are strong presumptive evidence for endocarditis, metastatic foci, or abscesses.