Fluoroquinolones vs. tetracycline agents combined with rifampicin for periprosthetic joint infections: a comparative...

Area of Science:

• Orthopedics
• Infectious Diseases
• Pharmacology

Background:

• Periprosthetic joint infections (PJIs) are primarily caused by gram-positive bacteria.
• Fluoroquinolones (FQs) combined with rifampicin (RMP) are common PJI treatments but may be limited by resistance, side effects, or intolerance.
• Second-generation tetracyclines (TTCs) present a promising alternative therapeutic option.

Purpose of the Study:

• To compare the efficacy and tolerance of RMP-TTC versus RMP-FQ combinations in treating staphylococcal and streptococcal PJIs.
• To evaluate treatment failure rates and adverse events between the two antibiotic regimens.

Main Methods:

• Retrospective study of 105 patients with staphylococcal/streptococcal PJIs treated between 2013-2021.
• Comparison of RMP-FQ (n=70) versus RMP-TTC (n=35) regimens over a 2-year follow-up period.
• Propensity score weighting (IPTW) and Cox regression analysis were used to compare outcomes and adjust for covariates.

Main Results:

• No significant difference in treatment failure was observed between RMP-TTC and RMP-FQ groups after IPTW adjustment (aHR 0.68; 95% CI 0.32-1.4).
• Subgroup analyses for *S. aureus* and coagulase-negative staphylococci (CoNS) also showed no significant differences in treatment failure.
• Similar rates of adverse events were reported for both treatment groups (20% vs. 19%, p > 0.9).

Conclusions:

• RMP-TTC therapy demonstrates comparable efficacy and safety to RMP-FQ for PJI treatment.
• RMP-TTC should be considered a potential therapeutic option for PJIs, especially when fluoroquinolones are contraindicated or not tolerated.