| Summary: | <i>Staphylococcus aureus</i> (<i>S. aureus</i>) is a ubiquitous pathogen responsible for several severe infections. This study aimed to investigate the adhesive properties and antibiotic resistance among clinical <i>S. aureus</i> isolated from Hail Hospital Province, Kingdom of Saudi Arabia (KSA), using molecular approaches. This study was conducted according to the ethical committee at Hail’s guidelines on twenty-four <i>S. aureus</i> isolates. A polymerase chain reaction (PCR) was performed to identify genes encoding the β-lactamase resistance (<i>bla</i>Z), methicillin resistance (<i>mec</i>A), fluoroquinolone resistance (<i>nor</i>A), nitric oxide reductase (<i>nor</i>B), fibronectin (<i>fnb</i>A and <i>fnb</i>B), clumping factor (<i>clf</i>A) and intracellular adhesion factors (<i>ica</i>A and <i>ica</i>D). This qualitative study tested adhesion based on exopolysaccharide production on Congo red agar (CRA) medium and biofilm formation on polystyrene by <i>S. aureus</i> strains. Among 24 isolates, the <i>cna</i> and blaz were the most prevalent (70.8%), followed by <i>nor</i>B (54.1%), <i>clf</i>A (50.0%), <i>nor</i>A (41.6%), <i>mec</i>A and <i>fnb</i>B (37.5%) and <i>fnb</i>A (33.3%). The presence of <i>ica</i>A/<i>ica</i>D genes was demonstrated in almost all tested strains in comparison to the reference strain, <i>S. aureus</i> ATCC 43300. The phenotypic study of adhesion showed that all tested strains had moderate biofilm-forming capacity on polystyrene and represented different morphotypes on a CRA medium. Five strains among the twenty-four harbored the four genes of resistance to antibiotics (<i>mec</i>A, <i>nor</i>A, <i>nor</i>B and <i>bla</i>z). Considering the genes of adhesion (<i>cna</i>, <i>clf</i>A, <i>fnb</i>A and <i>fnb</i>B), these genes were present in 25% of the tested isolates. Regarding the adhesive properties, the clinical isolates of <i>S. aureus</i> formed biofilm on polystyrene, and only one strain (S17) produced exopolysaccharides on Congo red agar. All these results contribute to an understanding that the pathogenesis of clinical <i>S. aureus</i> isolates is due to their antibiotic resistance and adhesion to medical material.
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