If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study.

Abstract

BACKGROUND:

Rifampin is generally advised in the treatment of acute staphylococcal periprosthetic joint infections (PJI). However, if, when, and how to use rifampin remains a matter of debate. We evaluated the outcome of patients treated with and without rifampin, and analyzed the influence of timing, dose and co-antibiotic.

METHODS:

Acute staphylococcal PJIs treated with surgical debridement between 1999 and 2017, and a minimal follow-up of 1 year were evaluated. Treatment failure was defined as the need for any further surgical procedure related to infection, PJI-related death or the need for suppressive antimicrobial treatment.

RESULTS:

A total of 669 patients were analyzed. Treatment failure was 32.2% (131/407) in patients treated with rifampin and 54.2% (142/262) in whom rifampin was withheld (P < .001). The most prominent effect of rifampin was observed in knees (treatment failure 28.6% versus 63.9%, respectively, P < .001). The use of rifampin was an independent predictor of treatment success in the multi-variate analysis (OR 0.30, 95% CI 0.20 - 0.45). In the rifampin group, the use of a co-antibiotic other than a fluoroquinolone or clindamycin (OR 10.1, 95% CI 5.65 - 18.2) and the start of rifampin within 5 days after surgical debridement (OR 1.96, 95% CI 1.08 - 3.65) were predictors of treatment failure. The dosing of rifampin had no effect on outcome.

CONCLUSIONS:

Our data supports the use of rifampin in acute staphylococcal PJIs treated with surgical debridement, particularly in knees. Immediate start of rifampin after surgical debridement should probably be discouraged, but requires further investigation.

• Authors: Mark Beldman, Claudia Löwik, Alex Soriano, Laila Albiach, Wierd P Zijlstra, Bas A S Knobben, Paul Jutte, Ricardo Sousa, André Carvalho, Karan Goswami, Javad Parvizi, Katherine A Belden, Marjan Wouthuyzen-Bakker
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 73 Issue 9 Pg. 1634-1641 (11 02 2021) ISSN: 1537-6591 [Electronic] United States
• PMID: 33970214 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.

Chemical References

• Anti-Bacterial Agents
• Rifampin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Debridement
• Humans
• Prosthesis-Related Infections (drug therapy)
• Retrospective Studies
• Rifampin (therapeutic use)
• Staphylococcal Infections (drug therapy)
• Staphylococcus
• Treatment Outcome