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Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been

Tobias Siegfried Kramer1,2,3, Alex Soriano4, Sarah Tedeschi5,6

  • 1Institute for Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.

Open Forum Infectious Diseases
|October 30, 2023
PubMed
Abstract

Insights

Rifampicin improves outcomes for chronic staphylococcal periprosthetic joint infections (PJIs) undergoing two-stage exchange surgery. This combination therapy, along with an extended antibiotic holiday, significantly reduces treatment failure rates in these complex cases.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Pharmacology

Background:

  • Staphylococcal periprosthetic joint infections (PJIs) are a significant complication of joint replacement surgery.
  • Rifampicin-based regimens have shown efficacy in acute PJIs treated with debridement, but evidence for implant exchange is limited.

Purpose of the Study:

  • To evaluate the efficacy of rifampicin in staphylococcal PJIs treated with revision surgery, specifically focusing on implant exchange.
  • To identify predictors of clinical success in these challenging cases.

Main Methods:

  • International, retrospective, multicenter observational cohort study of 375 patients with staphylococcal PJIs undergoing revision surgery (January 2013-December 2018).
  • PJI diagnosis based on European Bone and Joint Infection Society criteria.
  • Clinical failure defined as relapse, reinfection, need for suppressive therapy, implant removal, or PJI-related death.

Main Results:

  • No significant difference in failure rates between rifampicin and no-rifampicin groups overall (22.5% vs. 31.4%).
  • In chronic PJIs treated with 2-stage exchange, rifampicin use was associated with a significantly lower failure rate (15% vs. 35.5%, P = .005).
  • Rifampicin use and an antibiotic holiday >2 weeks were independent predictors of success in the 2-stage exchange subgroup.

Conclusions:

  • Combination treatment with rifampicin enhances treatment success in patients with chronic staphylococcal PJI undergoing 2-stage exchange arthroplasty.
  • Extended antibiotic holidays are also crucial for successful outcomes in these cases.
Keywords:
PJIperiprosthetic joint infectionrifampicinrifampinstaphylococci

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