Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been Exchanged? A Multicenter Observational Cohort Study.

Autor: Kramer TS; Institute for Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.; Clinic for Orthopedic Surgery and Traumatology, Evangelisches Waldkrankenhaus Berlin, Berlin, Deutschland.; LADR der Laborverbund Dr. Kramer & Kollegen, Geesthacht, Germany., Soriano A; Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain., Tedeschi S; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.; Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universistaria di Bologna, Bologna, Italy., Chen AF; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA., Tattevin P; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France., Senneville E; French National Referent Centre for Complex Bone and Joint Infections, CRIOAC Lille-Tourcoing, Lille, France., Gomez-Junyent J; Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain., Birlutiu V; Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, B-dul Ferdinand 35-37, Sector 2 Bucharest, Romania., Petersdorf S; Institute for Medical Laboratory Diagnostics, Helios University Clinic Wuppertal, Wuppertal, Germany., de Brito VD; Department of Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi (Barcelona), Spain., Gonzalez IS; Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Navarra, Pamplona, España., Belden KA; Division of Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA., Wouthuyzen-Bakker M; Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2023 Oct 06; Vol. 10 (10), pp. ofad491. Date of Electronic Publication: 2023 Oct 06 (Print Publication: 2023).
DOI: 10.1093/ofid/ofad491
Abstrakt: Background: Previous studies demonstrated the efficacy of a rifampicin-based regimen in the treatment of acute staphylococcal periprosthetic joint infections (PJIs) treated with surgical debridement. However, evidence is lacking to support the use of rifampicin in cases where the implant is exchanged during revision.
Methods: We included all consecutive cases of staphylococcal PJIs treated from January 2013 to December 2018 with revision surgery in this international, retrospective, multicenter observational cohort study. PJI was defined according to the European Bone and Joint Infection Society diagnostic criteria. A relapse or reinfection during follow-up, the need for antibiotic suppressive therapy, the need for implant removal, and PJI-related death were defined as clinical failure. Cases without reimplantation or with follow-up <12 months were excluded.
Results: A total of 375 cases were included in the final analysis, including 124 1-stage exchanges (33.1%) and 251 2-stage exchanges (66.9%). Of those, 101 cases failed (26.9%). There was no statistically significant difference in failure of patients receiving rifampicin (22.5%, 42/187) and those not receiving rifampicin (31.4%, 59/188; P = .051). A subanalysis of chronic PJIs treated by 2-stage exchange arthroplasty demonstrated a lower failure rate in cases treated with rifampicin (15%) compared with the no-rifampicin group (35.5%; P = .005). In this subgroup, the use of rifampicin and an antibiotic holiday of >2 weeks were independent predictors of clinical success (odds ratio [OR], 0.36; 95% CI, 0.15-0.88; and OR, 0.19; 95% CI, 0.04-0.90; respectively).
Conclusions: Combination treatment with rifampicin increases treatment success in patients with chronic staphylococcal PJI treated with 2-stage exchange arthroplasty.
Competing Interests: Potential conflicts of interest. All authors: no reported conflicts.
(© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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