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Evaluating the Link Between Postoperative Timing of Rifampicin Introduction and the Clinical and Microbiological
Valeria Dessert1,2, Steven M Maurer2, Marc S Maurer2
1Internal Medicine, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland.
Background/Objectives:
In staphylococcal implant infections, there is often discussion about the optimal postoperative timing of the introduction of rifampicin in the postoperative period with open wounds.
Methods:
We reviewed all adult patients with residual staphylococcal implant infections between January 2014 and May 2024. We analyzed the delay to rifampicin use in relation to therapeutic failures, infection recurrences, and development of ultimate rifampicin resistance.
Results:
Among 103 independent infection episodes, 47 (46%) contained the pathogen S. aureus, and the remainder were different coagulase-negative staphylococci. The median number of surgical interventions was one, and the median duration of postsurgical systemic antibiotic treatment was 84 days (interquartile range (IQR), 42-84 d). The median daily dose of oral rifampicin was 900 mg, and the median delay in its introduction was 5 days (IQR, 3-8 d). Overall, 18% of patients experienced an adverse event related to rifampicin (mostly gastrointestinal), requiring treatment to be stopped. The incidences of clinical failures and of microbiologically identical recurrences were 27% and 10%, respectively. The risk of rifampin resistance among any new staphylococcal infection or colonization during a median follow-up of 1.9 years was 1%. In the multivariate Cox regression analysis, the delay in rifampicin administration, its dose, or its duration failed to alter outcomes.
Conclusions:
In our retrospective cohort of staphylococcal orthopedic implant infections, the timing of rifampicin introduction failed to alter clinical and microbiological outcomes.
Insights
The timing of rifampicin introduction in staphylococcal implant infections did not impact treatment success or recurrence rates. This retrospective study found no significant difference in outcomes based on when rifampicin was initiated post-surgery.
Area of Science:
- Orthopedic surgery
- Infectious diseases
- Pharmacology
Background:
- Staphylococcal implant infections pose treatment challenges.
- Optimal timing for rifampicin (RIF) introduction in open wounds remains debated.
Purpose of the Study:
- To evaluate the impact of rifampicin timing on outcomes in staphylococcal implant infections.
- To analyze the relationship between delayed rifampicin use and therapeutic failures, recurrences, and resistance.
Main Methods:
- Retrospective review of adult patients with staphylococcal implant infections (Jan 2014 - May 2024).
- Analysis of delay to rifampicin administration, dose, and duration.
- Multivariate Cox regression to assess outcome predictors.
Main Results:
- 103 infection episodes analyzed; 46% caused by S. aureus.
- Median rifampicin delay was 5 days; 18% experienced adverse events.
- Clinical failure (27%) and recurrence (10%) rates were not significantly altered by rifampicin timing, dose, or duration.
Conclusions:
- In staphylococcal orthopedic implant infections, the timing of rifampicin introduction did not affect clinical or microbiological outcomes.
- Delayed rifampicin use did not increase failure, recurrence, or resistance rates in this cohort.
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