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

Publication

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

Journal Paper/Review - Jan 15, 2021

Kusejko Katharina, Ferrari Matteo Carlo, Gassmann Natalie, Sendi Parham, Jent Philipp, Morand Philippe C, Vijayvargiya Prakhar, Trebše Rihard, Patel Robin, Kouyos Roger D, Corvec Stéphane, Kramer Tobias Siegfried, Stadelmann Vincent A, Wouthuyzen-Bakker Marjan, Fernandez-Sampedro Marta, Clauss Martin, Auñón Álvaro, Jost Bernhard, Benito Natividad, Strahm Carol, Thurnheer Christine, Pablo-Marcos Daniel, Slama Dorsaf, Scanferla Giulia, Uçkay Ilker, Waldmann Isabelle, Esteban Jaime, Lora-Tamayo Jaime, Achermann Yvonne

Citation

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.

Type

Journal Paper/Review (English)

Journal

Clin Infect Dis 2021; 72

Publication Date

Jan 15, 2021

Issn Electronic

1537-6591

Pages

e1064-e1073

Brief description/objective

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.