Bacterial adherence to medical devices has been recognized as an important initial step in the infectious process, but it has not been fully elucidated regarding ventriculoperitoneal (VP) shunts. The aim of the present study was to quantitatively determine the adherence in vitro of bacteria known to cause VP shunt infections and to identify factors affecting the process. Clinical isolates studied included Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli. Adherence was examined quantitatively per square centimeter, visualized by electron microscopy and related to slime production and hydrophobicity. Although all four strains adhered to VP shunts, there were marked differences, with S. epidermidis and S. aureus showing the highest adherence (67.0 x 10(3) and 15.2 x 10(3) bacteria/cm(2), respectively). Factors affecting adherence included incubation time and temperature, bacterial concentration, device material (lower for silicone than Teflon), slime production and hydrophobicity. These data might be helpful for devising novel strategies to reduce VP shunt infections.