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Effectiveness of Different Antimicrobial Strategies for Staphylococcal Prosthetic Joint Infection: Results From a
Henk Scheper1, Robert J P van der Wal2, Rachid Mahdad3
1Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
Background:
Treatment of staphylococcal prosthetic joint infection (PJI) usually consists of surgical debridement and prolonged rifampicin combination therapy. Tailored antimicrobial treatment alternatives are needed due to frequent side effects and drug-drug interactions with rifampicin combination therapy. We aimed to assess the effectiveness of several alternative antibiotic strategies in patients with staphylococcal PJI.
Methods:
In this prospective, multicenter registry-based study, all consecutive patients with a staphylococcal PJI, treated with debridement, antibiotics and implant retention (DAIR) or 1-stage revision surgery between January 1, 2015 and November 3, 2020, were included. Patients were treated with a long-term rifampicin combination strategy (in 2 centers) or a short-term rifampicin combination strategy (in 3 centers). Antimicrobial treatment strategies in these centers were defined before the start of the registry. Patients were stratified in different groups, depending on the used antimicrobial strategy. Cox proportional hazards models were used to compare outcome between the groups.
Results:
Two hundred patients were included and stratified in 1 long-term rifampicin group (traditional rifampicin combination therapy) or 1 of 3 short-term rifampicin groups (clindamycin or flucloxacillin or vancomycin monotherapy, including rifampicin for only 5 postoperative days). Adjusted hazard ratios (aHRs) for failure in patients treated with short-term rifampicin and either flucloxacillin or clindamycin were almost equal to patients treated with long-term rifampicin combination therapy (aHR = 1.21; 95% confidence interval, .34-4.40).
Conclusions:
A short-term rifampicin strategy with either clindamycin or flucloxacillin and only 5 days of rifampicin was found to be as effective as traditional long-term rifampicin combination therapy. A randomized controlled trial is needed to further address efficacy and safety of alternative treatment strategies for staphylococcal PJI.
Insights
Short-term rifampicin regimens, using clindamycin or flucloxacillin for staphylococcal prosthetic joint infection (PJI), demonstrate comparable effectiveness to traditional long-term rifampicin therapy. This offers a promising alternative for PJI treatment.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Staphylococcal prosthetic joint infection (PJI) management typically involves surgical debridement and extended rifampicin combination therapy.
- Alternative antimicrobial strategies are needed due to rifampicin's side effects and drug interactions.
Purpose of the Study:
- To evaluate the efficacy of alternative antibiotic strategies for staphylococcal PJI.
Main Methods:
- Prospective, multicenter registry-based study including 200 patients with staphylococcal PJI undergoing debridement, antibiotics, and implant retention (DAIR) or 1-stage revision.
- Patients received either long-term rifampicin combination therapy or a short-term regimen (5 days of rifampicin with clindamycin, flucloxacillin, or vancomycin).
- Cox proportional hazards models were used to compare outcomes between treatment groups.
Main Results:
- Short-term rifampicin strategies with clindamycin or flucloxacillin showed similar failure rates to long-term rifampicin combination therapy (aHR = 1.21; 95% CI, .34-4.40).
- Vancomycin monotherapy was also assessed within the short-term rifampicin groups.
Conclusions:
- A short-term rifampicin strategy (5 days) combined with clindamycin or flucloxacillin is as effective as traditional long-term rifampicin therapy for staphylococcal PJI.
- Further randomized controlled trials are warranted to confirm the efficacy and safety of these alternative treatment strategies.
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