ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2026
Comparing Clinical, Microbiological, and Genetic Definitions of Relapse in Patients With Subsequent Episodes of Methicillin-resistant Staphylococcus aureus Bone and Joint Infection.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDifferentiation of a relapse from a new infection is challenging in patients with a recurrent bone or joint infection (BJI). We compared clinical, microbiological, and genomic definitions of relapse among patients with methicillin-resistant Staphylococcus aureus (MRSA) BJI.
methodsAll MRSA isolates obtained from BJIs between July 2018 and December 2022 from patients with at least 2 episodes of BJI from 2 U.S. hospitals underwent whole-genome sequencing. Distinct intrasubject lineages (ISLs) were defined as MRSA genomes from the same individual differing by <100 single nucleotide polymorphisms. Clinical, microbiological, and population genomic criteria were each separately compared with a gold standard for relapse versus new infection of genomically defined ISLs. The level of agreement was calculated with Cohen's kappa. A multivariable analysis was performed to define factors associated with the occurrence of recurrent episodes with different ISLs.
resultsWe included 264 isolates from 80 subjects with a range of 2-5 episodes spanning 16-1403 days. In total, 29 subjects (36%) had >1 ISL. Multilocus sequence type (ST) 8 was the most common (n = 147, 55.7%). In multivariable analysis, female sex and antibiotic susceptibility differences in MRSA strains were associated with >1 ISL. Compared with the genomic definition of relapse (same ISL), the level of agreement was poor (Cohen's kappa = -0.16) for the clinical definition, fair for the microbiological definition (Cohen's kappa = 0.29), and substantial for the MLST definition (Cohen's kappa = 0.63).
conclusionsClinical and microbiological criteria were not accurate in distinguishing a relapse of BJI from a new infection.
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