Publikation

The Impact of Surgical Strategy and Rifampin on Treatment Outcome in Cutibacterium Periprosthetic Joint Infections

Wissenschaftlicher Artikel/Review - 15.01.2021

Bereiche
PubMed
DOI
Kontakt

Zitation
Kusejko K, Ferrari M, Gassmann N, Sendi P, Jent P, Morand P, Vijayvargiya P, Trebše R, Patel R, Kouyos R, Corvec S, Kramer T, Stadelmann V, Wouthuyzen-Bakker M, Fernandez-Sampedro M, Clauss M, Auñón Á, Jost B, Benito N, Strahm C, Thurnheer C, Pablo-Marcos D, Slama D, Scanferla G, Uçkay I, Waldmann I, Esteban J, Lora-Tamayo J, Achermann Y. The Impact of Surgical Strategy and Rifampin on Treatment Outcome in Cutibacterium Periprosthetic Joint Infections. Clin Infect Dis 2021; 72:e1064-e1073.
Art
Wissenschaftlicher Artikel/Review (Englisch)
Zeitschrift
Clin Infect Dis 2021; 72
Veröffentlichungsdatum
15.01.2021
eISSN (Online)
1537-6591
Seiten
e1064-e1073
Kurzbeschreibung/Zielsetzung

BACKGROUND
Cutibacterium species are common pathogens in periprosthetic joint infections (PJI). These infections are often treated with β-lactams or clindamycin as monotherapy, or in combination with rifampin. Clinical evidence supporting the value of adding rifampin for treatment of Cutibacterium PJI is lacking.

METHODS
In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI and a minimal follow-up of 12 months. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection. We used Fisher's exact tests and Cox proportional hazards models to analyze the effect of rifampin and other factors on clinical success after PJI.

RESULTS
We included 187 patients (72.2% male, median age 67 years) with a median follow-up of 36 months. The surgical intervention was a 2-stage exchange in 95 (50.8%), 1-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%) patients. Rifampin was included in the antibiotic regimen in 81 (43.3%) cases. Infection relapse occurred in 28 (15.0%), and new infection in 13 (7.0%) cases. In the time-to-event analysis, DAIR (adjusted hazard ratio [HR] = 2.15, P = .03) and antibiotic treatment over 6 weeks (adjusted HR = 0.29, P = .0002) significantly influenced treatment failure. We observed a tentative evidence for a beneficial effect of adding rifampin to the antibiotic treatment-though not statistically significant for treatment failure (adjusted HR = 0.5, P = .07) and not for relapses (adjusted HR = 0.5, P = .10).

CONCLUSIONS
We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI, but a dedicated prospective multicenter study is needed.