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Background  There have been few studies focused on the prevalence, bacterial etiology, antibiotic resistance, and genetic background of  Staphylococcus aureus  ( S. aureus ) in children with acute otitis media (AOM) in China.    Methods  A retrospective study was conducted in Liuzhou Maternity and Child Healthcare Hospital. Patients younger than 18 years diagnosed with AOM were enrolled in the study. Middle ear fluid specimens were collected and cultured for bacterial pathogens. The antibiotic susceptibility, virulence genes, macrolide resistant genes and sequence types of  S. aureus  were identified.    Results  From January 1, 2013 to December 31, 2015, a total of 228 cases of AOM were identified. Pathogenic bacteria were positive in 181 (79.4%) of 228 specimens.  Streptococcus pneumoniae  was the most common bacteria (36.4%), followed by  S. aureus  (16.2%). Among the 37  S. aureus  isolates, 12 (23.5%) were methicillin-resistant  S. aureus  (MRSA), and 25 (77.5%) were methicillin-susceptible  S. aureus  (MSSA). A total of 23 isolates (62.2%) were resistant to erythromycin, 40.5% of isolates were resistant to clindamycin, and 37.8% isolates were resistant to tetracycline. Twenty-three isolates were multi-drug resistant (MDR)  S. aureus . Eighteen isolates carried the  pvl  gene. Up to 22 (59.4%) isolates expressed  ermA  gene, 8 (21.6%) isolates expressed both  ermA  and  ermC  genes, and only 8.1% expressed  ermB . Among all  S.aureus  isolates, 7 sequence types (STs) were identified by multilocus sequence typing (MLST). The most common ST was ST59 (16/37, 43.2%), followed by ST45 (7/37, 18.9%) and ST30 (7/37, 18.9%). The predominant MSSA isolates were ST59-t437-MSSA (5/25, 20.0%), the prevailing MRSA isolates were Taiwan related strains ST59-SCCmec-IVa/V (5/12, 41.6%).    Conclusions   S. aureus  was the second most common cause for AOM in children in Liuzhou. Most of the  S. aureus  was MDR which carried a high proportion of  ermA  and  ermC  gene. CA-MRSA (ST59-SCC mec -I V /V-t437) is circulating in children with AOM. These findings support continued surveillance of  S. aureus  infections in children with AOM in both communities and hospitals.

Molecular characterization and antimicrobial susceptibility of Staphylococcus aureus isolated from children with acute otitis media in Liuzhou, China