Rifampin in staphylococcal PJI
Trial question
What is the role of rifampin combination therapy in acute staphylococcal prosthetic joint infection treated with debridement and retention of the implant?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
33.3% female
66.7% male
N = 99
99 patients (16 female, 32 male)
Inclusion criteria: patients with prosthetic joint infection after hip and knee arthroplasties
Key exclusion criteria: prosthetic joint infection with other bacteria than staphylococci, expected survival < 2 years, inability to comply with treatment and/or follow-up visits, and contraindications to the use of rifampin, cloxacillin, or vancomycin
Interventions
N=23 rifampin combination therapy (rifampin plus cloxacillin in MSSA or rifampin plus vancomycin in methicillin-resistant S. epidermidis for 6 weeks)
N=25 monotherapy (cloxacillin in methicillin-susceptible staphylococci and vancomycin in methicillin-resistant S. epidermidis for 6 weeks)
Primary outcome
Rate of no signs of infection after 2 years of follow-up
74
72
74.0 %
55.5 %
37.0 %
18.5 %
0.0 %
Rifampin combination
therapy
Monotherapy
No significant
difference ↔
No significant difference in the rate of no signs of infection after 2 years of follow-up (74% vs. 72%; RR 1.03, 95% CI 0.73 to 1.45)
Secondary outcomes
No significant difference in cure rate for S. aureus infection (77.8% vs. 65%; RR 1.2, 95% CI 0.8 to 1.8)
No significant difference in cure rate for coagulase-negative Staphylococci (60% vs. 100%; RR 0.6, 95% CI 0.29 to 1.22)
Safety outcomes
No significant difference in discontinuation of rifampin or vancomycin due to side-effects.
Significant difference in increased serum-creatinine levels for rifampin and vancomycin (0% vs. 65%).
Conclusion
In patients with prosthetic joint infection after hip and knee arthroplasties, rifampin combination therapy was not superior to monotherapy with respect to the rate of no signs of infection after 2 years of follow-up.
Reference
Øystein Espeland Karlsen, Pål Borgen, Bjørn Bragnes et al. Rifampin combination therapy in staphylococcal prosthetic joint infections: a randomized controlled trial. J Orthop Surg Res. 2020 Aug 28;15(1):365.
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