TY - JOUR
T1 - The impact of surgical strategy and rifampin on treatment outcome in Cutibacterium periprosthetic joint infections
AU - Achermann, Yvonne
AU - Kusejko, Katharina
AU - Auñón, Álvaro
AU - Clauss, Martin
AU - Corvec, Stéphane
AU - Esteban, Jaime
AU - Fernandez-Sampedro, Marta
AU - Ferrari, Matteo Carlo
AU - Gassmann, Natalie
AU - Jent, Philipp
AU - Jost, Bernhard
AU - Kouyos, Roger D
AU - Kramer, Tobias Siegfried
AU - Lora-Tamayo, Jaime
AU - Morand, Philippe C
AU - Benito, Natividad
AU - Pablo-Marcos, Daniel
AU - Patel, Robin
AU - Scanferla, Giulia
AU - Sendi, Parham
AU - Slama, Dorsaf
AU - Stadelmann, Vincent A
AU - Strahm, Carol
AU - Thurnheer, Christine
AU - Trebše, Rihard
AU - Uckay, Ilker
AU - Vijayvargiya, Prakhar
AU - Waldmann, Isabelle
AU - Wouthuyzen-Bakker, Marjan
N1 - © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
PY - 2020/12/10
Y1 - 2020/12/10
N2 - 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.MATERIALS/METHODS: In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection within a minimal follow-up of 12 months. 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 two-stage exchange in 95 (50.8%), one-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%). 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 HR=2.15, p=0.03) and antibiotic treatment over 6 weeks (adjusted HR=0.29, p=0.0002) 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=0.07) and not for relapses (adjusted HR=0.5, p=0.10).CONCLUSIONS: We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI but a dedicated prospective multicenter study is needed.
AB - 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.MATERIALS/METHODS: In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection within a minimal follow-up of 12 months. 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 two-stage exchange in 95 (50.8%), one-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%). 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 HR=2.15, p=0.03) and antibiotic treatment over 6 weeks (adjusted HR=0.29, p=0.0002) 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=0.07) and not for relapses (adjusted HR=0.5, p=0.10).CONCLUSIONS: We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI but a dedicated prospective multicenter study is needed.
U2 - 10.1093/cid/ciaa1839
DO - 10.1093/cid/ciaa1839
M3 - Artículo
C2 - 33300545
SN - 1058-4838
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -