The impact of surgical strategy and rifampin on treatment outcome in Cutibacterium periprosthetic joint infections

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

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

Original languageAmerican English
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
DOIs
Publication statusE-pub ahead of print - 10 Dec 2020

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