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Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients

Stergios Lazarinis1, Nils P Hailer1, Josef D Järhult2

  • 1Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, Sweden.

Antibiotics (Basel, Switzerland)
|October 27, 2023
PubMed
Abstract

Insights

Rifampicin resistance in periprosthetic joint infections (PJI) did not increase, but resistant bacteria raise treatment failure risk over fourfold. Limiting resistance is crucial for effective PJI management.

Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Microbiology

Background:

  • Rifampicin is essential for treating periprosthetic joint infection (PJI).
  • Increasing rifampicin resistance poses a significant challenge to PJI treatment efficacy.
  • Understanding resistance trends and outcomes is vital for optimizing PJI management.

Purpose of the Study:

  • To investigate the incidence of rifampicin-resistant bacteria in PJI over two decades.
  • To analyze the association between rifampicin resistance and infection-free survival in PJI patients.
  • To evaluate the impact of rifampicin resistance on treatment failure rates.

Main Methods:

  • Retrospective analysis of 238 staphylococcal PJI cases (2001-2020) with available rifampicin susceptibility data.
  • Kaplan-Meier survival analysis to assess infection-free survival.
  • Cox regression modeling to determine adjusted hazard ratios for treatment failure.

Main Results:

  • Rifampicin-resistant bacteria were found in 17% of cases.
  • The proportion of resistant strains decreased from 24% (2010-2015) to 12% (2016-2020).
  • Patients with rifampicin-resistant PJI had a 4.2-fold increased risk of treatment failure and lower 2-year infection-free survival (78.6% vs. 90.0%).

Conclusions:

  • The incidence of rifampicin-resistant PJI has not increased over the past 20 years.
  • Rifampicin-resistant bacteria significantly increase the risk of treatment failure in PJI.
  • Strategies to limit the development of rifampicin resistance are essential for successful PJI treatment.
Keywords:
incidenceperiprosthetic joint infectionrifampicin resistancetreatment failure

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