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Rifampin in device-related infections: Assessing the modern evidence
Spencer H Durham1, Elizabeth W Covington2, Megan Z Roberts1
1Auburn University Harrison College of Pharmacy, Huntsville, AL, USA.
Purpose:
Rifampin is commonly used to treat device-related infections (DRIs) due to its activity against biofilms, despite a history of limited clinical evidence to support its use. Evidence published since 2011 regarding rifampin use for DRIs is reviewed to describe the contemporary findings and ongoing considerations for rifampin use in these infections.
Summary:
A literature review was performed by searching PubMed and Google Scholar to identify relevant studies evaluating systemic rifampin use for the treatment of DRIs published from 2011 to 2023. References of identified studies were also screened for additional pertinent studies. Sixty-eight studies were identified, and 48 met the inclusion criteria. Rifampin efficacy was evaluated as both a primary outcome for cardiac device infections (n = 3) and prosthetic joint infections (n = 21) and as a nonprimary outcome (n = 24). Overall, the studies were primarily retrospective (n = 36) and small, with sample sizes ranging from 14 to 842 patients, and varied greatly with respect to prosthesis site, surgical intervention, pathogen, infection time frame, and antibiotic combination and duration. Efficacy outcome results varied greatly, with statistically significant evidence for the efficacy of rifampin combination in DRIs limited to a single study of prosthetic vascular graft infections and 13 studies of prosthetic joint infections.
Conclusion:
The modern literature provides conflicting results regarding the benefit and lack of benefit with rifampin combination therapy in DRIs. Additional, robust research is imperative to solidify the ongoing role of rifampin in DRIs.
Insights
Rifampin combination therapy shows mixed results for device-related infections (DRIs). More research is needed to confirm its effectiveness against biofilm-forming bacteria in these complex cases.
Area of Science:
- Infectious Diseases
- Antimicrobial Therapy
- Medical Devices
Background:
- Rifampin is frequently used for device-related infections (DRIs) due to its anti-biofilm properties.
- Clinical evidence supporting rifampin's efficacy in DRIs has historically been limited.
Purpose of the Study:
- To review contemporary evidence (2011-2023) on rifampin use for DRIs.
- To describe current findings and considerations for rifampin in treating these infections.
Main Methods:
- A systematic literature review of PubMed and Google Scholar was conducted.
- Studies evaluating systemic rifampin for DRIs published between 2011 and 2023 were included.
- References of identified studies were screened for additional relevant research.
Main Results:
- 48 out of 68 identified studies met inclusion criteria.
- Studies were predominantly retrospective and small, with diverse methodologies.
- Statistically significant evidence for rifampin combination efficacy was limited to prosthetic joint infections and one study on vascular graft infections.
Conclusions:
- Current literature presents conflicting evidence on the benefits of rifampin combination therapy for DRIs.
- Robust research is essential to definitively establish rifampin's role in managing DRIs.
