The Impact of Surgical Strategy and Rifampin on Treatment Outcome in Cutibacterium Periprosthetic Joint Infections
Por:
Kusejko, K, Aunon, A, Jost, B, Natividad, B, Strahm, C, Thurnheer, C, Pablo-Marcos, D, Slama, D, Scanferla, G, Uckay, I, Waldmann, I, Esteban, J, Lora-Tamayo, J, Clauss, M, Fernandez-Sampedro, M, Wouthuyzen-Bakker, M, Ferrari, MC, Gassmann, N, Sendi, P, Jent, P, Morand, PC, Vijayvargiya, P, Trebse, R, Patel, R, Kouyos, RD, Corvec, S, Kramer, TS, Stadelmann, VA, Achermann, Y, ESCMID Study Grp Implant-Associate
Publicada:
15 jun 2021
Resumen:
Background. Cutibacterium species are common pathogens in periprosthetic joint infections (PJI). These infections are often treated with beta-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.
Methods. In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI and a minimal follow-up of 12 months. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection. 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 a 2-stage exchange in 95 (50.8%), 1-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%) patients. 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 hazard ratio [HR]=2.15, P=.03) and antibiotic treatment over 6 weeks (adjusted HR=0.29, P=.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=.07) and not for relapses (adjusted HR=0.5, P=.10).
Conclusions. We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI, but a dedicated prospective multicenter study is needed.
Filiaciones:
Kusejko, K:
Univ Zurich, Univ Hosp Zurich, Div Infect Dis & Hosp Epidemiol, Zurich, Switzerland
Aunon, A:
IIS Fdn Jimenez Diaz, Madrid, Spain
Jost, B:
Cantonal Hosp St Gallen, Dept Orthopaed & Traumatol, St Gallen, Switzerland
Natividad, B:
Univ Autonoma Barcelona, Dept Med, Hosp Santa Creu & St Pau, Inst dInvest Biomed St Pau, Barcelona, Spain
Strahm, C:
Cantonal Hosp St Gallen, Div Infect Dis & Hosp Epidemiol, St Gallen, Switzerland
Thurnheer, C:
Univ Bern, Bern Univ Hosp, Dept Infect Dis, Bern, Switzerland
Pablo-Marcos, D:
Hosp Univ Marques Valdecilla, Cantabria, Spain
Slama, D:
Cochin Hosp, Paris, France
Scanferla, G:
Cantonal Hosp St Gallen, Div Infect Dis & Hosp Epidemiol, St Gallen, Switzerland
Uckay, I:
Univ Hosp Zurich, Orthoped Univ Hosp Balgrist, Zurich, Switzerland
Waldmann, I:
Univ Zurich, Univ Hosp Zurich, Div Infect Dis & Hosp Epidemiol, Zurich, Switzerland
Esteban, J:
IIS Fdn Jimenez Diaz, Madrid, Spain
Lora-Tamayo, J:
Hosp Univ 12 Octubre, Madrid, Spain
Clauss, M:
Univ Basel, Univ Hosp Basel, Ctr Musculoskeletal Infect, Dept Orthoped & Trauma Surg, Liestal, Switzerland
Kantonsspi Tat Baselland, Liestal, Switzerland
Fernandez-Sampedro, M:
Hosp Univ Marques Valdecilla, Cantabria, Spain
Wouthuyzen-Bakker, M:
Univ Groningen, Univ Med Ctr Groningen, Dept Med Microbiol & Infect Prevent, Groningen, Netherlands
Ferrari, MC:
Humanitas Clin & Res Ctr IRCCS & Humanitas Univ, Dept Biomed Sci, Milan, Italy
Gassmann, N:
Univ Zurich, Univ Hosp Zurich, Div Infect Dis & Hosp Epidemiol, Zurich, Switzerland
Sendi, P:
Univ Basel, Univ Hosp Basel, Div Infect Dis & Hosp Epidemiol, Basel, Switzerland
Jent, P:
Univ Bern, Bern Univ Hosp, Dept Infect Dis, Bern, Switzerland
Morand, PC:
Univ Paris, Cochin Hosp, APHP Ctr, Paris, France
Vijayvargiya, P:
Mayo Clin, Rochester, MN USA
Trebse, R:
Univ Ljubljana, Valdoltra Orthoped Hosp, Med Fac, Ankaran, Slovenia
Patel, R:
Mayo Clin, Rochester, MN USA
Kouyos, RD:
Univ Zurich, Univ Hosp Zurich, Div Infect Dis & Hosp Epidemiol, Zurich, Switzerland
Univ Zurich, Inst Med Virol, Zurich, Switzerland
Corvec, S:
Univ Nantes, Ctr Hosp Univ Nantes, Serv Bacteriol Hyg Hosp, CRCINA, Nantes, France
Kramer, TS:
Charite Univ Med Berlin, Berlin, Germany
Germany Evangel Waldkrankenhaus Spandau, Berlin, Germany
LADR Zentrallab Dr Kramer & Kollegen, Geesthacht, Germany
Stadelmann, VA:
Schulthess Clin, Dept Res & Dev, Zurich, Switzerland
Achermann, Y:
Univ Zurich, Univ Hosp Zurich, Div Infect Dis & Hosp Epidemiol, Zurich, Switzerland
Green Accepted, Green Published
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