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. 2022 Sep 13;9(10):ofac474.
doi: 10.1093/ofid/ofac474. eCollection 2022 Oct.

Effectiveness of Different Antimicrobial Strategies for Staphylococcal Prosthetic Joint Infection: Results From a Large Prospective Registry-Based Cohort Study

Henk Scheper  1 , Robert J P van der Wal  2 , Rachid Mahdad  3 , Stefan Keizer  4 , Nathalie M Delfos  5 , Joris C T van der Lugt  6 , Karin Ellen Veldkamp  7 , Peter A Nolte  8 , Masja Leendertse  9 , Luc B S Gelinck  10 , Femke P N Mollema  10 , Emile F Schippers  1   11 , Hanke G Wattel-Louis  12 , Leo G Visser  1 , Rob G H H Nelissen  2 , Mark G J de Boer  1
Affiliations

Effectiveness of Different Antimicrobial Strategies for Staphylococcal Prosthetic Joint Infection: Results From a Large Prospective Registry-Based Cohort Study

Henk Scheper et al. Open Forum Infect Dis. .

Abstract

Background: Treatment of staphylococcal prosthetic joint infection (PJI) usually consists of surgical debridement and prolonged rifampicin combination therapy. Tailored antimicrobial treatment alternatives are needed due to frequent side effects and drug-drug interactions with rifampicin combination therapy. We aimed to assess the effectiveness of several alternative antibiotic strategies in patients with staphylococcal PJI.

Methods: In this prospective, multicenter registry-based study, all consecutive patients with a staphylococcal PJI, treated with debridement, antibiotics and implant retention (DAIR) or 1-stage revision surgery between January 1, 2015 and November 3, 2020, were included. Patients were treated with a long-term rifampicin combination strategy (in 2 centers) or a short-term rifampicin combination strategy (in 3 centers). Antimicrobial treatment strategies in these centers were defined before the start of the registry. Patients were stratified in different groups, depending on the used antimicrobial strategy. Cox proportional hazards models were used to compare outcome between the groups.

Results: Two hundred patients were included and stratified in 1 long-term rifampicin group (traditional rifampicin combination therapy) or 1 of 3 short-term rifampicin groups (clindamycin or flucloxacillin or vancomycin monotherapy, including rifampicin for only 5 postoperative days). Adjusted hazard ratios (aHRs) for failure in patients treated with short-term rifampicin and either flucloxacillin or clindamycin were almost equal to patients treated with long-term rifampicin combination therapy (aHR = 1.21; 95% confidence interval, .34-4.40).

Conclusions: A short-term rifampicin strategy with either clindamycin or flucloxacillin and only 5 days of rifampicin was found to be as effective as traditional long-term rifampicin combination therapy. A randomized controlled trial is needed to further address efficacy and safety of alternative treatment strategies for staphylococcal PJI.

Keywords: DAIR; antimicrobial strategies; rifampicin combination treatment; staphylococcal prosthetic joint infection; vancomycin.

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Figures

Figure 1.
Figure 1.
Flowchart of inclusion for current study. DAIR, debridement, antibiotics and implant retention; PJI, prosthetic joint infection.
Figure 2.
Figure 2.
Survival analysis for staphylococcal prosthetic joint infection related to antimicrobial treatment strategy. (A) Success rates over time for the different antibiotic groups as defined in Table 1. (B) Success rates over time for the same antibiotic groups but using a narrower definition of failure in which all patient who needed a second surgery were counted as failure.
See this image and copyright information in PMC

References

    1. Sabah SA, Alvand A, Price AJ. Revision knee replacement for prosthetic joint infection: epidemiology, clinical outcomes and health-economic considerations. Knee 2021; 28:417–21. - PubMed
    1. RIVM . Report Postoperative Wound Infetions The Netherlands 2015–2019. Available at: https://www.rivm.nl/documenten/referentiecijfers-powi-2019. Accessed 1 February 2022.
    1. Manning L, Metcalf S, Clark B, et al. . Clinical characteristics, etiology, and initial management strategy of newly diagnosed periprosthetic joint infection: a multicenter, prospective observational cohort study of 783 patients. Open Forum Infect Dis 2020; 7:ofaa068. - PMC - PubMed
    1. Osmon DR, Berbari EF, Berendt AR, et al. . Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56:e1–25. - PubMed
    1. Nguyen S, Robineau O, Titecat M, et al. . Influence of daily dosage and frequency of administration of rifampicin–levofloxacin therapy on tolerance and effectiveness in 154 patients treated for prosthetic joint infections. Eur J Clin Microbiol Infect Dis 2015; 34:1675–82. - PubMed