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Adjunctive Rifampin Following Debridement and Implant Retention for Staphylococcal Prosthetic Joint Infection: Is it Effective if not Combined With a Fluoroquinolone?

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Authors/contributors
Abstract
Whether rifampin benefits retained staphylococcal prosthetic joint infection is unsettled. In a meta-analysis of 8 studies, we found greater clinical cure with fluoroquinolone-rifampin vs all other regimens (odds ratio [OR], 2.68; 95% CI, 1.43–5.02), but no greater cure with other rifampin combinations vs regimens without rifampin (OR, 1.22; 95% CI, 0.79–1.88).
Publication
Open Forum Infectious Diseases
Date
2022-12-02
DOI
10.1093/ofid/ofac582
URL
https://academic.oup.com/ofid/article/doi/10.1093/ofid/ofac582/6783132
Notes

Key Question: Does adjunctive rifampin improve cure rates when combined with non-fluoroquinolone antibiotics for the treatment of staphylococcal prosthetic joint infections (PJIs) managed with debridement and implant retention (DAIR)?

Key Findings:

  • Fluoroquinolone-rifampin combination therapy was associated with higher cure rates compared to other regimens (OR 2.68, 95% CI 1.43-5.02).
  • Non-fluoroquinolone rifampin combinations were not associated with improved cure rates compared to regimens without rifampin (OR 1.22, 95% CI 0.79-1.88).

Clinical Implications:

  • Adding rifampin to non-fluoroquinolone antibiotics may not improve cure rates for staphylococcal PJIs treated with DAIR.
  • Fluoroquinolone-rifampin combination therapy may lead to better outcomes compared to other regimens.

Strengths:

  • Systematic review and meta-analysis of 8 studies
  • Findings consistent with results of 2 RCTs
  • No evidence of publication bias for key comparison of fluoroquinolone-rifampin vs. regimens without rifampin

Limitations:

  • Most studies were retrospective and subject to confounding
  • Heterogeneity between studies in rifampin dosing
  • Possibility of publication bias exaggerating benefit of fluoroquinolone-rifampin combinations
  • Fluoroquinolone-rifampin may have been used in healthier patients predisposed to better outcomes (confounding by indication)
Citation
1.
Cortés-Penfield NW, Hewlett AL, Kalil AC. Adjunctive Rifampin Following Debridement and Implant Retention for Staphylococcal Prosthetic Joint Infection: Is it Effective if not Combined With a Fluoroquinolone? Open Forum Infectious Diseases. 2022;9(12):ofac582.
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