Poly-N-acetyl-glucosamine (PNAG) is a staphylococcal surface polysaccharide influencing biofilm formation that is also under investigation for its vaccine potential. Antibodies that bind to PNAG with either low (<15%) or high (>90%) levels of acetate are superior at opsonic and protective activity compared with antibodies that bind to PNAG with only high levels (>70%) of acetate. PNAG is synthesized by four proteins encoded within the intercellular adhesin (ica) locus icaADBC. In Staphylococcus epidermidis, icaB encodes a deacetylase needed for the surface retention of PNAG and optimal biofilm formation. In this study, we confirmed that icaB plays a similar role in Staphylococcus aureus and found that an icaB mutant of S. aureus expressed significantly less surface-associated PNAG, was highly susceptible to antibody-independent opsonic killing that could not be enhanced with antibody raised against deacetylated PNAG (dPNAG), and had reduced survival capacity in a murine model of bacteremia. In contrast, an icaB-overexpressing strain produced primarily surface-associated PNAG, was more susceptible to opsonophagocytosis with antibody to dPNAG, and had increased survival in a murine bacteremia model. The highly acetylated secreted PNAG was more effective at blocking opsonic killing mediated by a human monoclonal antibody (mAb) to native PNAG than it was at blocking killing mediated by a human mAb to dPNAG, which by itself was a more effective opsonin. Retention of dPNAG on the surface of S. aureus is key to increased survival during bacteremia and also provides a molecular mechanism explaining the superior opsonic and protective activity of antibody to dPNAG.Staphylococcus aureus and coagulase-negative staphylococci are the most frequent causes of nosocomial bloodstream infections (43). A critical virulence determinant in such infections is the production of a high-molecular-weight polymer of -1-6-linked N-acetyl-glucosamine (PNAG) that is involved in adherence to polymeric substrates, bacterial intercellular adhesion, biofilm formation, and protection against antibodyindependent opsonic killing (3,4,15,26,40). Proteins encoded by the icaADBC genes of the intercellular adhesin (ica) locus synthesize PNAG (6, 10-12, 30, 31). IcaA is a trans-membrane glucosyltransferase and can synthesize short PNAG polymers in vitro using UDP-N-acetyl-glucosamine as a substrate (10). IcaD increases the biosynthetic efficiency of IcaA (10). IcaC is also a transmembrane protein and appears to be involved in linking short polymers to make longer oligomers of PNAG (10). In its mature form, PNAG, also referred to by some researchers as polysaccharide intercellular adhesin (PIA) (12,44), is a mixture of polymers such that about 10 to 20% of the amino groups are not acetylated, which could give some of the polymers within the polysaccharide complex a net positive charge (16,27). It is not known whether PNAG consists of a minority of highly deacetylated molecules mixed in with a majority of highly acetylated molecules or if there is a rang...