Genomic and clinical characteristics of <i>Staphylococcus aureus</i> isolates associated with orthopedic infections from a rural hospital, Qingdao, China

Orthopedic infections caused by Staphylococcus aureus remain a major clinical and public health concern, especially in rural regions where diagnostic and therapeutic capacities are limited. This study represents one of the first integrated clinical-genomic analyses of <i>S. aureus</i> from orthopedic infections in rural China. By combining patient-level data with phenotypic and genomic characterization, we reveal high rates of multidrug resistance, heterogeneous virulence and resistance gene profiles, and the emergence of novel sequence types. Comparative phylogenetic analyses demonstrate strong genetic links between rural Chinese isolates and globally disseminated lineages, emphasizing the international movement of epidemic clones. Together with antibiotic treatment data, these findings underscore the need for rational antimicrobial use, infection control, and continuous genomic surveillance. The discovery of novel lineages highlights ongoing local evolution of <i>S. aureus</i> and supports the importance of integrating genomics into orthopedic infection management and antimicrobial resistance mitigation in resource-limited settings.