Rifampin Use in Staphylococcal Prosthetic Joint Infections

Background Prosthetic joint infection (PJI) remains one of the most serious complications of prosthetic joint implantation. For patients with PJI managed with debridement, antibiotics, and implant retention (DAIR) surgical approach, two to six weeks of targeted intravenous antibiotics plus rifampin is typically recommended. Subsequently, rifampin plus a second oral antibiotic is given for a total of three versus six months for hip and knee arthroplasty infections, respectively. The goal of our study was to evaluate whether adjunctive rifampin affects treatment outcomes in patients with staphylococcal PJI. Methods We performed a retrospective study including patients aged > 18 with a diagnosis of prosthetic hip or knee infection due to staphylococcal species from January 2016 to December 2021. Patients were excluded if they did not receive appropriate anti-staphylococcal antibiotics, required resection arthroplasty or amputation, received a two-stage exchange as the initial surgical treatment, or were treated at another institution. The primary endpoint was treatment failure. Secondary endpoints included implant removal, long-term suppressive oral antibiotic utilization, hepatotoxicity, early rifampin discontinuation, and PJI-related mortality within one year. Results A total of 34 patients were included in the study, with 16 patients in the rifampin group (RIF) and 18 patients in the non-rifampin group (non-RIF). Most patients underwent DAIR for PJI management in both groups: 13/16 (81.3%) in RIF vs. 11/18 (61.1%) in non-RIF. The most common staphylococcalspecies causing infection was methicillin-susceptible Staphylococcus aureus (MSSA) in both groups. Treatment failure occurred in 2/16 (12.5%) of RIF patients vs. 9/18 (50%) of non-RIF patients (P = 0.030). The median duration of RIF therapy was 42 days, with 2/16 (12.5%) patients discontinuing rifampin early due to drug intolerance. Conclusions Recommendations for rifampin use in PJI vary in the literature. Despite its limitations, this study shows that at our institution, there was a statistically significant benefit conferred by rifampin usage in PJI treatment.