Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
Comparing Clinical, Microbiological, and Genetic Definitions of Relapse in Patients With Subsequent Episodes of Methicillin-resistant Staphylococcus aureus Bone and Joint Infection.
СтатьяСравнительное исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Bouiller Kevin, Cella Eleonora, Jacko Natasia F, Hiehle Maeve E, Azarian Taj, David Michael Z
Аннотация
BACKGROUND: Differentiation 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.
METHODS: All 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.
RESULTS: We 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).
CONCLUSIONS: Clinical and microbiological criteria were not accurate in distinguishing a relapse of BJI from a new infection.
METHODS: All 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.
RESULTS: We 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).
CONCLUSIONS: Clinical and microbiological criteria were not accurate in distinguishing a relapse of BJI from a new infection.