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Early Staphylococcal Periprosthetic Joint Infection (PJI) Treated with Debridement, Antibiotics, and Implant

Hannah K Eriksson1, Stergios Lazarinis1, Josef D Järhult2

  • 1Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, 751 83 Uppsala, Sweden.

Antibiotics (Basel, Switzerland)
|November 24, 2023
PubMed

Insights

Rifampicin resistance in staphylococci significantly increases the risk of relapse in patients with early periprosthetic joint infection (PJI) treated with debridement, antibiotics, and implant retention (DAIR). This suggests DAIR may be ineffective for PJI caused by resistant strains.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Microbiology

Background:

  • Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
  • Staphylococcal infections are a common cause of PJI.
  • The impact of rifampicin resistance in staphylococci on PJI treatment outcomes remains unclear.

Purpose of the Study:

  • To compare the risk of infection relapse in early PJI patients treated with debridement, antibiotics, and implant retention (DAIR).
  • To evaluate outcomes based on whether the causative staphylococci were resistant or sensitive to rifampicin.

Main Methods:

  • Retrospective analysis of 81 patients with early PJI treated with DAIR.
  • Relapse-free survival estimated using Kaplan-Meier method.
  • Cox regression models used to assess the adjusted risk of infection relapse.

Main Results:

  • Patients with rifampicin-resistant staphylococci had higher relapse rates: 80% after one DAIR, 70% after two.
  • Patients with rifampicin-sensitive bacteria had lower relapse rates: 51% after one DAIR, 33% after two.
  • Rifampicin resistance increased the adjusted risk of relapse by 1.9-fold after one DAIR and 4.1-fold after two DAIR procedures (p < 0.05).

Conclusions:

  • Staphylococcal resistance to rifampicin is linked to poorer outcomes in DAIR treatment for PJI.
  • DAIR may not be a suitable treatment strategy for early PJI caused by rifampicin-resistant staphylococci.
  • Further research into alternative treatment strategies for resistant PJI is warranted.
Keywords:
DAIRPJIantibioticsdebridementimplant retentionperiprosthetic joint infectionrifampicinstaphylococcus

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