Among patients who develop periprosthetic joint infection (PJI) following total joint arthroplasty, the addition of rifampin to standard care may decrease the risk for subsequent treatment failure, according to results of a study published in The Journal of Arthroplasty.
Researchers conducted a meta-analysis of comparative studies that evaluated the effect of rifampin vs standard care for the treatment of PJI. Studies included in the analysis were conducted between 1998 and 2021, and the majority were retrospective cohort studies. The primary outcome was treatment failure and the secondary outcome was the incidence of adverse events.
A total of 33 studies were included in the meta-analysis, representing 5133 patients. Of note, standard care was not well defined in most studies.
There were 8 studies (n=945) that reported adverse events related to the use of rifampin alone for the treatment of PJI. Results showed that 194 (20.5%) patients experienced an adverse event, and rifampin was discontinued in 111 (11.7%). The most common adverse events were related to gastrointestinal complications and the most severe were reported among patients who experienced hepatotoxicity and nephrotoxicity.
A total of 22 studies representing 2530 patients assessed the addition of rifampin to standard care compared with standard care alone. Of these patients, 1366 received rifampin plus standard care and 1164 received standard care alone. Compared with patients who received standard care alone, the rate of treatment failure was decreased among those who received rifampin plus standard care (25.1% vs 35.9%; odds ratio [OR], 0.57; 95% CI, 0.41-0.78).
Further analysis was conducted among 13 studies that included specific pathogens found among patients with PJI. Of these studies, 7 (n=1311) included patients with Staphylococcal infections, 4 (n=282) included those with Streptococcal infections, and 2 (n=247) included those with Cutibacterium infections. After stratification by causative organism, the researchers found that rifampin was protective against treatment failure in all cases of infection. Among patients with Staphylococcal, Streptococcal, and Cutibacterium infections, the use of rifampin statistically significantly decreased the risk for treatment failure, with ORs of 0.64 (95% CI, 0.43-0.95), 0.36 (95% CI, 0.14-0.93), and 0.44 (95% CI, 0.22-0.89), respectively.
Limitations included potential bias as the majority of the included studies had a retrospective design, differences in rifampin dosage regimens, and the inclusion of multiple definitions in regard to treatment success and treatment failure.
According to the researchers, “[additional] high-level evidence is needed to clarify when the use of rifampin is warranted and the most effective dose to improve the odds of successful treatment [among patients with] PJI.”
Kruse C, Ekhtiari S, Oral I, et al. The use of rifampin in total joint arthroplasty: a systematic review and meta-analysis of comparative studies. J Arthroplasty. Published online March 22, 2022. doi:10.1016/j.arth.2022.03.072