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Methicillin-Resistant  Staphylococcus aureus  (MRSA) is a significant threat to human health. Additionally, biofilm forming bacteria becomes more tolerant to antibiotics and act as bacterial reservoir leading to chronic infection. In this study, we characterised the antibiotic susceptibility, biofilm production and sequence types (ST) of 74 randomly selected clinical isolates of  S. aureus  causing ocular infections. Antibiotic susceptibility revealed 74% of the isolates as resistant against one or two antibiotics, followed by 16% multidrug-resistant isolates (MDR), and 10% sensitive. The isolates were characterized as MRSA (n = 15), Methicillin-sensitive  S. aureus  (MSSA, n = 48) and oxacillin susceptible  mecA  positive  S. aureus  (OS-MRSA, n = 11) based on oxacillin susceptibility,  mecA  gene PCR and PBP2a agglutination test. All OS-MRSA would have been misclassified as MSSA on the basis of susceptibility test. Therefore, both phenotypic and genotypic tests should be included to prevent strain misrepresentation. In addition, in-depth studies for understanding the emerging OS-MRSA phenotype is required. The role of  fem XAB  gene family has been earlier reported in OS-MRSA phenotype. Sequence analysis of the  fem XAB  genes revealed mutations in  fem  × (K3R, H11N, N18H and I51V) and  fem B  (L410F) genes. The  fem XAB  genes were also found down-regulated in OS-MRSA isolates in comparison to MRSA. In OS-MRSA isolates, biofilm formation is regulated by fibronectin binding proteins A & B. Molecular typing of the isolates revealed genetic diversity. All the isolates produced biofilm, however, MRSA isolates with strong biofilm phenotype represent a worrisome situation and may even result in treatment failure.

Decreased expression of femXAB genes and fnbp mediated biofilm pathways in OS-MRSA clinical isolates