{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T10:51:08Z","timestamp":1783421468889,"version":"3.54.6"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 &amp;lt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 264 isolates from 80 subjects with a range of 2\u20135 episodes spanning 16\u20131403 days. In total, 29 subjects (36%) had &amp;gt;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 &amp;gt;1 ISL. Compared with the genomic definition of relapse (same ISL), the level of agreement was poor (Cohen's kappa = \u22120.16) 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinical and microbiological criteria were not accurate in distinguishing a relapse of BJI from a new infection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf448","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T12:10:23Z","timestamp":1754655023000},"page":"402-410","source":"Crossref","is-referenced-by-count":2,"title":["Comparing Clinical, Microbiological, and Genetic Definitions of Relapse in Patients With Subsequent Episodes of Methicillin-resistant\n                    <i>Staphylococcus aureus<\/i>\n                    Bone and Joint Infection"],"prefix":"10.1093","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2177-4318","authenticated-orcid":false,"given":"Kevin","family":"Bouiller","sequence":"first","affiliation":[{"name":"Department of Infectious and Tropical Diseases, Universit\u00e9 Marie et Louis Pasteur, CHU Besan\u00e7on, UMR-CNRS 6249 Chrono-Environnement , Besan\u00e7on ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7870-9744","authenticated-orcid":false,"given":"Eleonora","family":"Cella","sequence":"additional","affiliation":[{"name":"Burnett School of Biomedical Sciences, University of Central Florida , Orlando, Florida ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8295-7951","authenticated-orcid":false,"given":"Natasia F","family":"Jacko","sequence":"additional","affiliation":[{"name":"Division of 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