Skip to main content
Log in

Efficacy and safety of rifampin containing regimen for staphylococcal prosthetic joint infections treated with debridement and retention

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the efficacy and safety of rifampin for Staphylococcus aureus (SA) or coagulase negative staphylococci (CNS) prosthetic joint infection (PJI) treated with debridement and retention (D/R). We calculated the treatment failure cumulative incidence (TF) of a cohort of 101 patients with SA or CNS PJI treated with D/R and antimicrobial therapy. The effect of the use of a rifampin-based regimen was evaluated. Cox proportional hazards regression evaluated the association between treatment and time-to-TF controlling for the propensity to treat with rifampin and temporal confounders. Seven percent (1/14) of the prospective rifampin-treated patients, 32% (10/31) of the historical rifampin-treated patients and 38% (21/56) of the historical non-rifampin treated patients developed TF. After controlling for the propensity to treat with rifampin and American Society of Anesthesia scores, patients in the prospective cohort had a lower risk of TF compared to patients in the historical cohort not treated with rifampin (HR 0.11; 95%CI 0.01–0.84). None (0/14) of the patients in the prospective study developed hepatotoxicity. The outcome of staphylococcal PJI treated with D/R and rifampin-based regimens was better when compared with a historical cohort treated without rifampin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kurtz S, Lau E, Halpern M, Ong K (2006) Trend shows growing orthopedic surgery case load. Will surgeons be able to keep up? Mater Manag Health Care 15(7):61–62

    PubMed  Google Scholar 

  2. Fisman DN, Reilly DT, Karchmer AW, Goldie SJ (2001) Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis 32(3):419–430

    Article  CAS  PubMed  Google Scholar 

  3. Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA (2007) Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am 89(3):526–533

    Article  PubMed  Google Scholar 

  4. Crockarell JR, Hanssen AD, Osmon DR, Morrey BF (1998) Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 80(9):1306–1313

    CAS  PubMed  Google Scholar 

  5. Tsukayama DT, Wicklund B, Gustilo RB (1991) Suppressive antibiotic therapy in chronic prosthetic joint infections. Orthopedics 14(8):841–844

    CAS  PubMed  Google Scholar 

  6. Choong PF, Dowsey MM, Carr D, Daffy J, Stanley P (2007) Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampin-based regimen. Acta Orthop 78(6):755–765

    Article  PubMed  Google Scholar 

  7. Drancourt M, Stein A, Argenson JN, Roiron R, Groulier P, Raoult D (1997) Oral treatment of Staphylococcus spp. infected orthopaedic implants with fusidic acid or ofloxacin in combination with rifampicin. J Antimicrob Chemother 39(2):235–240

    Article  CAS  PubMed  Google Scholar 

  8. Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE (1998) Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA 279(19):1537–1541

    Article  CAS  PubMed  Google Scholar 

  9. IIstrup D (1996) Reconstruction surgery of the joints. In: Statistical considerations and the science of surveillance. Churchill-Livingston, New York, pp 225–230

  10. Kurland LT, Molgaard CA (1981) The patient record in epidemiology. Sci Am 245(4):54–63

    Article  CAS  PubMed  Google Scholar 

  11. Berbari EF, Marculescu C, Sia I et al (2007) Culture-negative prosthetic joint infection. Clin Infect Dis 45(9):1113–1119

    Article  PubMed  Google Scholar 

  12. Berbari EF, Osmon DR, Duffy MC et al (2006) Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis 42(2):216–223

    Article  PubMed  Google Scholar 

  13. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284

    Article  Google Scholar 

  14. Barberan J, Aguilar L, Carroquino G et al (2006) Conservative treatment of staphylococcal prosthetic joint infections in elderly patients. Am J Med 119(11):993.e7–10

    Article  Google Scholar 

  15. Schrenzel J, Harbarth S, Schockmel G et al (2004) A randomized clinical trial to compare fleroxacin-rifampicin with flucloxacillin or vancomycin for the treatment of staphylococcal infection. Clin Infect Dis 39(9):1285–1292

    Article  CAS  PubMed  Google Scholar 

  16. Murillo O, Domenech A, Garcia A et al (2006) Efficacy of high doses of levofloxacin in experimental foreign-body infection by methicillin-susceptible Staphylococcus aureus. Antimicrob Agents Chemother 50(12):4011–4017

    Article  CAS  PubMed  Google Scholar 

  17. Shirtliff ME, Calhoun JH, Mader JT (2001) Comparative evaluation of oral levofloxacin and parenteral nafcillin in the treatment of experimental methicillin-susceptible Staphylococcus aureus osteomyelitis in rabbits. J Antimicrob Chemother 48(2):253–258

    Article  CAS  PubMed  Google Scholar 

  18. Harris LG, Richards RG (2006) Staphylococci and implant surfaces: a review. Injury 37(Suppl 2):S3–S14

    Article  PubMed  Google Scholar 

  19. Stewart PS, Costerton JW (2001) Antibiotic resistance of bacteria in biofilms. Lancet 358(9276):135–138

    Article  CAS  PubMed  Google Scholar 

  20. Aboltins CA, Page MA, Buising KL et al (2007) Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. Clin Microbiol Infect 13(6):586–591

    Article  CAS  PubMed  Google Scholar 

  21. Barberan J (2006) Management of infections of osteoarticular prosthesis. Clin Microbiol Infect 12(Suppl 3):93–101

    Article  CAS  PubMed  Google Scholar 

  22. Soriano A, Garcia S, Bori G et al (2006) Treatment of acute post-surgical infection of joint arthroplasty. Clin Microbiol Infect 12(9):930–933

    Article  CAS  PubMed  Google Scholar 

  23. Giulieri SG, Graber P, Ochsner PE, Zimmerli W (2004) Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection 32(4):222–228

    Article  CAS  PubMed  Google Scholar 

  24. Marculescu CE, Berbari EF et al (2006) Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 42(4):471–478

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

Funding for this study was provided by OrthoNcNeil; it did not influence the content of this manuscript and did not contribute to the analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. F. Berbari.

Additional information

Each author certifies that the institution has approved the human protocol for this investigation (IRB# 415-05) and that all investigations were conducted in conformity with ethical principles of research.

Rights and permissions

Reprints and permissions

About this article

Cite this article

El Helou, O.C., Berbari, E.F., Lahr, B.D. et al. Efficacy and safety of rifampin containing regimen for staphylococcal prosthetic joint infections treated with debridement and retention. Eur J Clin Microbiol Infect Dis 29, 961–967 (2010). https://doi.org/10.1007/s10096-010-0952-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-010-0952-9

Keywords

Navigation