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Oxacillin-resistant  Staphylococcus lugdunensis  (ORSL) is considered a life-threatening isolate in healthcare settings. Among ORSL clones, ST6-SCC mec  II strains are associated with an endemic spread in hospitals. We analyzed the complete genome of ORSL CGMH-SL118, a representative strain. Results revealed that this strain contained three MGEs (two prophages and one plasmid) other than the SCC mec  II element, which showed remarkable differences in genome organization compared to the reference strains from NCBI. Eight multidrug-resistant genes were identified. All but  blaZ  were carried by MGEs, such as the SCC mec  II element [ mecA ,  ant  (9)-Ia, and  ermA ] and the prophage φSPbeta [ aac  (6')- aph  (2'),  aph  (3')-III, and  ant  (6)-Ia], indicating that MGEs carrying multidrug-resistant genes may be important for ST6 strains. The prophage φSPbeta contains  sasX  gene, which was responsible for the pathogenesis of  Staphylococcus aureus . A phage-mediated resistant island containing  fusB  (SlRI  fusB -118 ) was found near φSPbeta, which was highly homologous to type III SeRI  fusB -5907  of  Staphylococcus epidermidis . In contrast to previous studies, over 20% of ST6 isolates showed a fusidic acid-resistant phenotype, suggesting that phage-mediated intraspecies transmission of resistant islands may become an important issue for ST6 strains. Sixty-eight clinical isolates of ST6  Staphylococcus lugdunensis  (50 OSSL, oxacillin-sensitive  S. lugdunensis , and 18 ORSL, including CGMH-SL118) collected from various types of specimens in the hospital were studied. Among these isolates in this study, ORSL showed similar drug-resistant genes and phenotypes as CGMH-SL118. The comparative genomic analyses highlight the contribution of MGEs in the development and dissemination of antimicrobial resistance in ST6 strains, suggesting that resistance determinants and virulence factors encoded by MGEs provide a survival advantage for successful colonization and spread in healthcare settings.

Comparative Genomic Analyses Reveal Potential Factors Responsible for the ST6 Oxacillin-Resistant Staphylococcus lugdunensis Endemic in a Hospital