Rifampin combination therapy in staphylococcal prosthetic joint infections: a randomized controlled trial
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(2020) 15:365
RESEARCH ARTICLE
Open Access
Rifampin combination therapy in staphylococcal prosthetic joint infections: a randomized controlled trial Øystein Espeland Karlsen1,2* , Pål Borgen3, Bjørn Bragnes4, Wender Figved5, Bjarne Grøgaard1, Jonas Rydinge1, Lars Sandberg6, Finnur Snorrason1, Helge Wangen7, Eivind Witsøe8 and Marianne Westberg1
Abstract Background: The evidence supporting rifampin combination therapy in prosthetic joint infections (PJI) is limited due to the lack of controlled studies. The aim of this study is to evaluate the effect of adding rifampin to conventional antimicrobial therapy in early staphylococcal PJIs treated with debridement and retention of the implant (DAIR). Methods: In this multicenter randomized controlled trial, 99 patients with PJI after hip and knee arthroplasties were enrolled. They were randomly assigned to receive rifampin or not in addition to standard antimicrobial treatment with cloxacillin or vancomycin in case of methicillin resistance. The primary endpoint was no signs of infection after 2 years of follow-up. Results: Forty-eight patients were included in the final analyses. There were no differences in patient characteristics or comorbidities between the two groups. There was no significant difference in remission rate between the rifampin combination group (17 of 23 (74%)) and the monotherapy group (18 of 25 (72%), relative risk 1.03, 95% confidence interval 0.73 to 1.45, p = 0.88). Conclusion: This trial has not proven a statistically significant advantage by adding rifampin to standard antibiotic treatment in acute staphylococcal PJIs. Trial registration: The Regional Ethics Committee and the Norwegian Medicines Agency approved the study (EudraCT 2005-005494-29), and the study was registered at ClinicalTrials.gov at Jan 18, 2007 (NCT00423982). Keywords: Rifampin, Staphylococci, Prosthetic joint infection, Surgery
Highlights/summary Rifampin is increasingly used in staphylococcal prosthetic joint infections treated with debridement and retention of the prosthesis. This study is the largest randomized controlled study on this subject. No
* Correspondence: [email protected] 1 Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway 2 Department of Orthopaedic Surgery, Betanien Hospital, Skien, Norway Full list of author information is available at the end of the article
statistical significant advantage by adding rifampin to the antimicrobial medication is shown.
Introduction The number of patients requiring prosthetic joint replacement is increasing due to good functional outcome and excellent pain relief in a growing population of the elderly [1]. Prosthetic joint infection (PJI) is a rare but devastating complication occurring in 1–2% of primary interventions [2, 3] and in 2–20% of revision procedures [4]. PJI leads to increased morbidity, long periods of
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and re
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