Journal article
Effectiveness and Optimal Duration of Adjunctive Rifampin Treatment in the Management of Staphylococcus aureus Prosthetic Joint Infections After Debridement, Antibiotics, and Implant Retention
Open forum infectious diseases, Vol.9(9), pp.ofac473-ofac473
09/01/2022
DOI: 10.1093/ofid/ofac473
PMCID: PMC9522668
PMID: 36196299
Abstract
Abstract
Background
Rifampin is recommended as adjunctive therapy for patients with a Staphylococcus aureus prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR), with no solid consensus on the optimal duration of therapy. Our study assessed the effectiveness and optimal duration of rifampin for S aureus PJI using Veterans Health Administration (VHA) data.
Methods
We conducted a retrospective cohort study of patients with S aureus PJI managed with DAIR between 2003 and 2019 in VHA hospitals. Patients who died within 14 days after DAIR were excluded. The primary outcome was a time to microbiological recurrence from 15 days up to 2 years after DAIR. Rifampin use was analyzed as a time-varying exposure, and time-dependent hazard ratios (HRs) for recurrence were calculated according to the duration of rifampin treatment.
Results
Among 4624 patients, 842 (18.2%) received at least 1 dose of rifampin; 1785 (38.6%) experienced recurrence within 2 years. Rifampin treatment was associated with significantly lower HRs for recurrence during the first 90 days of treatment (HR, 0.60 [95% confidence interval {CI}, .45–.79]) and between days 91 and 180 (HR, 0.16 [95% CI, .04–.66]) but no statistically significant protective effect was observed with longer than 180 days (HR, 0.57 [95% CI, .18–1.81]). The benefit of rifampin was observed for subgroups including knee PJI, methicillin-susceptible or -resistant S aureus infection, and early or late PJI.
Conclusions
This study supports current guidelines that recommend adjunctive rifampin use for up to 6 months among patients with S aureus PJI treated with DAIR.
In this retrospective cohort study, rifampin treatment was associated with significantly lower hazard ratios for microbiological recurrence during the first 180 days of treatment among patients with staphylococcal prosthetic joint infections treated with debridement, antibiotics, and implant retention.
Details
- Title: Subtitle
- Effectiveness and Optimal Duration of Adjunctive Rifampin Treatment in the Management of Staphylococcus aureus Prosthetic Joint Infections After Debridement, Antibiotics, and Implant Retention
- Creators
- Hiroyuki Suzuki - Iowa City VA Health Care SystemMichihiko Goto - Iowa City VA Health Care SystemRajeshwari Nair - Roy J. and Lucille A. Carver College of MedicineDaniel J Livorsi - Iowa City VA Health Care SystemPoorani Sekar - Roy J. and Lucille A. Carver College of MedicineMichael E Ohl - Iowa City VA Health Care SystemDaniel J Diekema - Roy J. and Lucille A. Carver College of MedicineEli N Perencevich - Iowa City VA Health Care SystemBruce Alexander - Iowa City VA Health Care SystemMichael P Jones - University of Iowa, Center for Social Science InnovationJennifer S McDaniel - University of IowaMarin L Schweizer - Iowa City VA Health Care System
- Resource Type
- Journal article
- Publication Details
- Open forum infectious diseases, Vol.9(9), pp.ofac473-ofac473
- DOI
- 10.1093/ofid/ofac473
- PMID
- 36196299
- PMCID
- PMC9522668
- NLM abbreviation
- Open Forum Infect Dis
- ISSN
- 2328-8957
- eISSN
- 2328-8957
- Publisher
- Oxford University Press
- Grant note
- name: Veterans Affairs Health Services Research and Development Career Development Award, award: CDA 11-215
- Language
- English
- Date published
- 09/01/2022
- Academic Unit
- Statistics and Actuarial Science; Pharmacy; Psychiatry; Infectious Diseases; Epidemiology; Pathology; Biostatistics; Center for Social Science Innovation; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984303929202771
Metrics
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