Study Finds Rifampin Effective for Acute Staphylococcal Periprosthetic Joint Infections

Rifampin has been shown to be effective for the treatment of acute staphylococcal periprosthetic joint infections (PJIs) following surgical debridement, according to study results published in Clinical Infectious Diseases.

Patients (N=669) diagnosed with acute PJI of the hip or knee and treated with surgical debridement and implant retention (DAIR) were recruited from European and US hospitals from 1999 to 2017. Early acute PJI was defined as an infection within 90 days after index arthroplasty, and late acute PJI was defined as symptom onset after 90 days. Patients were assessed for treatment failure — defined as the need for additional surgical procedure(s) related to infection, PJI-related death, or the need for suppressive antimicrobial therapy — within 1 year of DAIR and for clinical outcomes.

The study patients had early (n=617) or late (n=52) PJI, and 61% were treated with rifampin.  Of those receiving treatment, 43.5% were men, 23.4% were older than 80 years, and 48.1% had a body mass index greater than 30 kg/m². Patients who received rifampin were more likely to have cemented implants (P =.001) and less likely to present with acute PJI (P <.001).

Treatment failure — defined as the need for additional surgical procedure(s) related to infection, PJI-related death, or the need for suppressive antimicrobial therapy — occurred among 273 patients. Treatment failure was more likely to occur among patients with high C-reactive protein (>115 mg/L; adjusted odds ratio [aOR], 2.31; 95% CI, 1.53-3.49; P <.001), Staphylococcus aureus infection (aOR, 1.88; 95% CI, 1.26-2.79; P =.002), and a cemented implant (aOR, 1.69; 95% CI, 1.09-2.63; P =.02). Treatment failure also was more likely to occur among men (aOR, 1.59; 95% CI, 1.09-2.31; P =.02) and patients with increased leukocytes (>12 cells/mL; aOR, 1.55; 95% CI, 1.02-2.35; P =.04).

Treatment failure was decreased among patients treated with rifampin (aOR, 0.30; 95% CI, 0.20-0.45; P <.001) and those receiving a primary implant (aOR, 0.59; 95% CI, 0.36-0.95; P =.03). Among patients who received rifampin, 131 experienced treatment failure. Treatment failure was associated with the use of a nonfluoroquinolone or clindamycin coantibiotic (aOR, 10.1; 95% CI, 5.65-18.2; P <.001), increased leukocytes (>12 cells/mL; aOR, 2.79; 95% CI, 1.48-5.27; P =.002), diabetes (aOR, 2.16; 95% CI, 1.12-4.15; P =.022), male sex (aOR, 2.07; 95% CI, 1.19-3.58; P =.009), and rifampin administration within 5 days following surgical debridement (aOR, 1.96; 95% CI, 1.08-3.56; P =.03).

Rifampin use more strongly prevented treatment failure among patients who had undergone knee implantation (P <.001) compared with hip implantation (P =.02) but had a similar effect on clinical failure (both P <.001). Mortality was decreased among the rifampin recipients (hazard ratio [HR], 0.54; 95% CI, 0.42-0.69; P <.0001).

This study may have been limited by not assessing microbiologic failure or the development of drug resistance. However, the study data indicated that rifampin had high efficacy in the treatment of acute staphylococcal PJIs following surgical debridement.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Beldman M, Löwik C, Soriano A, et al. If, when, and how to use rifampin in acute staphylococcal periprosthetic joint infections, a multicentre observational study. Clin Infect Dis. Published online May 10, 2021. doi:10.1093/cid/ciab426