If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study.
If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study.
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DOI：
10.1093/cid/ciab426
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发表时间：
2021-11-02
期刊：
影响因子：
--
通讯作者：
Wouthuyzen-Bakker M
中科院分区：
文献类型：
--
作者：
Beldman M;Löwik C;Soriano A;Albiach L;Zijlstra WP;Knobben BAS;Jutte P;Sousa R;Carvalho A;Goswami K;Parvizi J;Belden KA;Wouthuyzen-Bakker M
利福平通常被建议用于治疗急性葡萄球菌性假体周围关节感染（PJI）。然而，是否、何时以及如何使用利福平仍是一个有争议的问题。我们评估了使用和不使用利福平治疗的患者的预后，并分析了时间、剂量和联合抗生素的影响。对1999年至2017年期间接受外科清创治疗的急性葡萄球菌性PJIs进行了评估，并进行了1年的最短随访。治疗失败被定义为需要任何与感染、pji相关死亡相关的进一步外科手术或需要进行抑制性抗菌治疗。共分析669例患者。接受利福平治疗的患者治疗失败率为32.2%(131/407)，未使用利福平的患者治疗失败率为54.2% (142/262)（P < 0.001）。利福平对膝关节的治疗效果最为显著（治疗失败率分别为28.6%和63.9%,P < 0.001）。在多因素分析中，利福平的使用是治疗成功的独立预测因子（OR 0.30, 95% CI 0.20 - 0.45）。在利福平组中，使用氟喹诺酮类或克林霉素以外的联合抗生素（or 10.1, 95% CI 5.65 - 18.2）和手术清创后5天内开始使用利福平（or 1.96, 95% CI 1.08 - 3.65）是治疗失败的预测因子。利福平的剂量对结果没有影响。我们的数据支持利福平在急性葡萄球菌性PJIs手术清创治疗中的应用，特别是在膝关节。手术清创后立即开始使用利福平可能是不鼓励的，但需要进一步调查。这项多中心观察性研究一致地证明了以利福平为基础的方案在治疗急性葡萄球菌感染方面的附加价值。最大的益处是在膝关节，氟喹诺酮或克林霉素作为联合抗生素的成功率最高。
Rifampin is generally advised in the treatment of acute staphylococcal periprosthetic joint infections (PJI). However, if, when, and how to use rifampin remains a matter of debate. We evaluated the outcome of patients treated with and without rifampin, and analyzed the influence of timing, dose and co-antibiotic. Acute staphylococcal PJIs treated with surgical debridement between 1999 and 2017, and a minimal follow-up of 1 year were evaluated. Treatment failure was defined as the need for any further surgical procedure related to infection, PJI-related death or the need for suppressive antimicrobial treatment. A total of 669 patients were analyzed. Treatment failure was 32.2% (131/407) in patients treated with rifampin and 54.2% (142/262) in whom rifampin was withheld (P < .001). The most prominent effect of rifampin was observed in knees (treatment failure 28.6% versus 63.9%, respectively, P < .001). The use of rifampin was an independent predictor of treatment success in the multi-variate analysis (OR 0.30, 95% CI 0.20 – 0.45). In the rifampin group, the use of a co-antibiotic other than a fluoroquinolone or clindamycin (OR 10.1, 95% CI 5.65 – 18.2) and the start of rifampin within 5 days after surgical debridement (OR 1.96, 95% CI 1.08 – 3.65) were predictors of treatment failure. The dosing of rifampin had no effect on outcome. Our data supports the use of rifampin in acute staphylococcal PJIs treated with surgical debridement, particularly in knees. Immediate start of rifampin after surgical debridement should probably be discouraged, but requires further investigation. This multicentre observational study consistently demonstrates the added value of a rifampin-based regimen in the treatment of acute staphylococcal infections. The greatest benefit was observed in knees, and a fluoroquinolone or clindamycin showed the highest success rate as co-antibiotic.
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DOI：
10.1016/j.ijantimicag.2017.04.011
发表时间：
2018-01-01
影响因子：
10.8
作者：
Wouthuyzen-Bakker, Marjan;Tornero, Eduard;Soriano, Alex
通讯作者：
Soriano, Alex
影响因子：
3.7
作者：
Fiaux E;Titecat M;Robineau O;Lora-Tamayo J;El Samad Y;Etienne M;Frebourg N;Blondiaux N;Brunschweiler B;Dujardin F;Beltrand E;Loiez C;Cattoir V;Canarelli JP;Hulet C;Valette M;Nguyen S;Caron F;Migaud H;Senneville E;G4 bone and joint infection study group (G4BJIS)
通讯作者：
G4 bone and joint infection study group (G4BJIS)
影响因子：
11.8
作者：
Lora-Tamayo, Jaime;Murillo, Oscar;Ariza, Javier
通讯作者：
Ariza, Javier
影响因子：
120.7
作者：
Zimmerli, W;Widmer, AF;Ochsner, PE
通讯作者：
Ochsner, PE
影响因子：
6.4
作者：
WIDMER, AF;FREI, R;ZIMMERLI, W
通讯作者：
ZIMMERLI, W