Treatment of prosthetic joint infections due to Propionibacterium. Similar results in 60 patients treated with and without rifampicin

Abstract

Background and purpose: Currently, Propionibacterium is frequently recognized as a causative microorganism of prosthetic joint infection (PJI). We assessed treatment success at 1- and 2-year follow-up after treatment of Propionibacterium-associated PJI of the shoulder, hip, and knee. Furthermore, we attempted to determine whether postoperative treatment with rifampicin is favorable.

Patients and methods: We conducted a retrospective cohort study in which we included patients with a primary or revision joint arthroplasty of the shoulder, hip, or knee who were diagnosed with a Propionibacterium-associated PJI between November 2008 and February 2013 and who had been followed up for at least 1 year.

Results: We identified 60 patients with a Propionibacterium-associated PJI with a median duration of 21 (0.1-49) months until the occurrence of treatment failure. 39 patients received rifampicin combination therapy, with a success rate of 93% (95% CI: 83-97) after 1 year and 86% (CI: 71-93) after 2 years. The success rate was similar in patients who were treated with rifampicin and those who were not.

Interpretation: Propionibacterium-associated PJI treated with surgery in combination with long-term antibiotic administration had a successful outcome at 1- and 2-year follow-up irrespective of whether the patient was treated with rifampicin. Prospective studies are needed to determine whether the use of rifampicin is beneficial in the treatment of Propionibacterium-associated PJI.

Figure 1.

Kaplan-Meier survival curve of 60 patients treated for Propionibacterium-associated PJI. The cumulative success rate was 93% (95% CI: 83–97) and 86% (95% CI: 71–93) after 1 year and 2 years, respectively. The small vertical spikes represent the censored data.

Figure 2.

Comparison of Kaplan-Meier survival curves of patients treated for Propionibacterium-associated PJI with and without rifampicin combination therapy. A cumulative success rate of 90% (95% CI: 67–98) and 82% (95% CI: 53–94) was found in patients treated without rifampicin after 1 year and 2 years, respectively. A cumulative success rate of 95% (95% CI: 81–99) after 1 year and 88% (95% CI: 69–95) after 2 year was reached in patients treated with rifampicin. Overall comparison of the cumulative success rates revealed a p-value of 0.7 (log-rank test). The small vertical spikes represent the censored data.