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The Use of Rifampin in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Comparative Studies

Authors/contributors
Abstract
Background: Periprosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty (TJA). Rifampin is an antibiotic with the ability to penetrate bacterial biofilms, and thus has been considered as a potentially important adjunct in the prevention and treatment of PJI. The aim of this systematic review is to evaluate and summarize the use of rifampin in TJA, particularly in the context of PJI. Methods: A literature search of all relevant electronic databases was performed. All comparative studies assessing the use of rifampin in the context of TJA were included. Descriptive data are reported, and a meta-analysis was performed using all studies which compared the addition of rifampin to standard care in treating PJI. Results: A total of 33 studies met inclusion criteria. A meta-analysis of 22 studies comparing the addition of rifampin to standard care for treating PJI found a significant reduction in failure rates (26.0% vs 35.9%; odds ratio 0.61, 95% confidence interval 0.43-0.86). The protective effect of rifampin was maintained in studies which included exchange arthroplasty as a treatment strategy, but not in studies only using an implant retention strategy. Among studies reporting adverse events of rifampin, there was a 20.5% adverse event rate. Conclusion: Overall, rifampin appears to confer a protective effect against treatment failure following PJI. This treatment effect is particularly pronounced in the context of exchange arthroplasty. Further highlevel evidence is needed to clarify the exact indications and doses of rifampin which can most effectively act as an adjunct in the treatment of PJI.
Publication
The Journal of Arthroplasty
Date
08/2022
Notes

Article summary:

The article reviews the existing literature on the use of rifampin in the treatment of PJIs. A systematic review and meta-analysis of 33 studies were conducted, including both randomized controlled trials (RCTs) and retrospective cohorts. The studies evaluated the addition of rifampin to standard care in various treatment strategies, such as DAIR, implant exchange, excision arthroplasty, suppressive antibiotic treatment, and arthrodesis involving knee and hip prosthetic joints.

The results of the meta-analysis showed that the addition of rifampin was associated with a lower likelihood of treatment failure compared to standard care alone. However, the protective effect was more pronounced in staged revision surgeries than in DAIR procedures, even though evidence of use in staged revision surgeries were limited to cohort studies. The analysis also indicated that rifampin had a significant protective impact regardless of the causative organism, such as Staphylococcal, Streptococcal, or Cutibacterium infections.

The article also discussed the adverse effects of rifampin, with gastrointestinal issues being the most commonly reported adverse events. Some patients required discontinuation of rifampin due to these adverse events. The overall quality of the included studies varied, and the risk of bias was assessed using appropriate tools.

Citation
1.
Kruse CC, Ekhtiari S, Oral I, et al. The Use of Rifampin in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Comparative Studies. The Journal of Arthroplasty. 2022;37(8):1650-1657.