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Meta-Analysis
. 2024 Jan 25;78(1):40-47.
doi: 10.1093/cid/ciad560.

Rifampin Based Therapy for Patients With Staphylococcus aureus Native Vertebral Osteomyelitis: A Systematic Review and Meta-analysis

Said El Zein  1 , Elie F Berbari  1 , Matteo Passerini  2 , Francesco Petri  2 , Julian Maamari  3 , M Hassan Murad  1 , Parham Sendi  4 , Aaron J Tande  1
Affiliations
Meta-Analysis

Rifampin Based Therapy for Patients With Staphylococcus aureus Native Vertebral Osteomyelitis: A Systematic Review and Meta-analysis

Said El Zein et al. Clin Infect Dis. .

Abstract

Background: Native vertebral osteomyelitis (NVO) caused by Staphylococcus aureus is associated with high risk of treatment failure and increased morbidity. The role of rifampin-based therapy for the treatment of this condition is controversial. The goal of this systematic review and meta-analysis is to explore the efficacy and safety of rifampin-based therapy for the treatment of S. aureus NVO.

Methods: We searched Cochrane, Embase, Medline, Scopus, and Web of Science databases for studies published up to May 2023, focusing on adults with NVO treated with or without rifampin-containing regimens. A random-effects model meta-analysis estimated relative risks and risk difference with 95% confidence intervals (CI).

Results: Thirteen studies (2 randomized controlled trials and 11 comparative cohort studies), comprising 244 patients with S. aureus NVO who received rifampin and 435 who did not, were analyzed. Meta-analysis showed that rifampin-based regimens were associated with lower risk of clinical failure (risk difference, -14%; 95% CI, -19% to -8%; P < .001; I2 = 0%; relative risk, 0.58; 95% CI, .37-.92, P = .02, I2 = 21%). Only 1 study reported on adverse events. All studies had a high or uncertain risk of bias, and the certainty of evidence was rated as very low.

Conclusions: Adjunctive rifampin therapy might be associated with lower risk of S. aureus NVO treatment failure; however, the low certainty of evidence precludes drawing definitive conclusions that would alter clinical practice. A randomized trial is necessary to corroborate these findings.

Keywords: NVO; native vertebral osteomyelitis; rifampicin; rifampin; spondylodiscitis.

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Conflict of interest statement

Potential conflicts of interest. S. E. Z, E. F. B. , M. P., F. P., J. M., M. H. M., P. S., and A. J. T. declare no competing interests. A. J. T. reports honoraria for medical writing from UpToDate; a role as unpaid executive board member for Musculoskeletal Infection Society. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
Figure 2.
Figure 2.
Forest plot of 13 studies comparing the risk of treatment failure in patients with Staphylococcus aureus native vertebral osteomyelitis treated with adjunctive rifampin or not. Abbreviations: CI, confidence interval; M-H, Mantel-Haenszel.
Figure 3.
Figure 3.
Forest plot comparing the risk of treatment failure in patients with Staphylococcus aureus native vertebral osteomyelitis (NVO) treated with adjunctive rifampin or not, stratified by methicillin resistance. Methicillin resistance status did not significantly modify the effect of adjunctive rifampin compared with standard of care on the risk of clinical failure (P = .3). There is no significant heterogeneity between study results within each subgroup that require further exploration. However, a smaller number of studies and patients contributed data to the methicillin-resistant S. aureus (3 studies, 52 patients) compared with the methicillin-susceptible S. aureus (7 studies, 383 patients); therefore, the analysis may not be able to detect subgroup differences. Abbreviations: CI, confidence interval; M-H, Mantel-Haenszel; MRSA, methicillin resistant Staphylococcus aureus.
Figure 4.
Figure 4.
A, Risk of bias summary: review authors' judgments about each risk of bias item for each included study. B, Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.
See this image and copyright information in PMC

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