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A murine nasal colonization model and in vitro adhesion assays using A549 human epithelial cells were employed to evaluate colonization and adherence capabilities.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Penicillin-susceptible Staphylococcus aureus (PSSA) showed a significant rise during the study period, particularly within clonal complex ST398, which exhibited enhanced biofilm-forming capabilities. Phylogenetic analysis revealed minimal transmission events, suggesting independent cases. Comparative genetic analysis demonstrated distinct human-adaptive features in MRSA and MSSA-ST398 strains. PSSA-ST398 strains exhibited superior biofilm formation and increased adherence to human epithelial cells and murine nasal cavities compared with penicillin-resistant counterparts, indicating a potential advantage in colonization and persistence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Penicillin-susceptible ST398 strains, particularly those with strong biofilm-forming capabilities, which increase their persistence in clinical settings, complicating treatment and eradication efforts, represent a significant threat to OAIs. Despite being penicillin-susceptible, these strains may still pose challenges due to their biofilm-mediated resistance and potential for chronic infection.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaf208","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T11:42:53Z","timestamp":1751456573000},"page":"2295-2304","source":"Crossref","is-referenced-by-count":0,"title":["Penicillin-susceptible ST398 with strong biofilm-forming ability poses a significant threat to osteoarticular infections"],"prefix":"10.1093","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1761-7728","authenticated-orcid":false,"given":"Ye","family":"Jin","sequence":"first","affiliation":[{"name":"Department of General Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou, Zhejiang ,","place":["People\u2019s Republic of China"]},{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious 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