Antimicrobial Treatment of Orthopedic Implant-related Infections with Rifampin Combinations

Abstract

The purpose of this prospective clinical study is to evaluate the role of combination chemotherapy with rifampin in the treatment of orthopedic device-related infections in which the implant could not be removed. Eleven patients with orthopedic implant-related infections due to staphylococci or streptococci were treated with the implant in situ. Each antimicrobial regimen included rifampin in combination with a 19-lactam antibiotic or ciprofloxacin. The median duration of treatment with rifampin was 86 days (range, 15-336 days) with a median follow-up of >24 months after cessation of therapy. Treatment was successful for 82% of patients. Failures were associated with documented inappropriate treatment. These preliminary clinical data are supported by data from in vitro studies and animal experiments. Combination therapy with rifampin, in particular rifampin and a quinolone, should be considered for patients with orthopedic implant-related infections if the implant cannot be removed.Long-term intravenous therapy combined with a one-or two-stage replacement is frequently necessary for controlling orthopedic device-related infection (ODRI) [1]. New antimicrobial regimens may cure infections that were previously considered as necessitating removal of the device [2]. We previously observed in an animal model that even short-term treatment with rifampin can sterilize implant-related infections due to Staphylococcus epidermidis and Staphylococcus aureus [3][4][5]. The present trial was designed as a pilot study for evaluating whether a rifampin-containing regimen could cure ODRIs rather than only suppress the clinical symptoms. We applied such a regimen to 11 patients who had ODRIs and from whom the device could not be removed.We prospectively observed 11 patients (five women and six men) with ODRIs due to gram-positive cocci who were consulted by physicians from the Division of Infectious Diseases (A

Effects of rifampicin on osteogenic differentiation and proliferation of human mesenchymal stem cells in the bone marrow

“…Rifampicin is a potent antibiotic that is especially effective against Staphylococcus, which sometimes show resistance to beta-lactam antibiotics (Henry et al, 1987;Dworkin et al, 1990;O'Reilly et al, 1992;Littlewood-Evans et al, 1997;Rissing, 1997;Costerton et al, 1999). Furthermore, rifampicin has been shown to be an effective agent for treating bacteria in biofilms (Widmer et al, 1992), which Costerton et al (1999) reported to be important in the pathogenesis of bone and joint infection. Therefore, rifampicin has been recommended in the treatment of prosthesis infections (Rissing, 1997).…”

“…Several studies shown that after oral administration of rifampicin, the rifampicin concentration in bone and in the joint tuberculosis focus was lower than the effective bactericidal concentration (Roth, 1984;Widmer et al, 1992;Mahajan et al, 1997;Zimmerli et al, 1998;Isefuku et al, 2001). Therefore, the topical application of rifampicin on tuberculosis foci has been considered as an approach worth investigating.…”

Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampin‐based regimen

“…The duration of symptoms is important, since several studies have shown a high success rate (82-100%) with debridement and retention, if the duration is 3 weeks (Burger et al 1991, Widmer et al 1992, Zimmerli et al 1998, Tattevin et al 1999, Meehan et al 2003, Barberan 2006, Laffer et al 2006. The time to diagnosis of infection, described by Choong et al (2007) ranged from 5 to 105 days.…”

Articulating Spacers Used in Two-stage Revision of Infected Hip and Knee Prostheses Abrade with Time

“…When infections occur within 4 weeks of implantation, the implant can be left in place with a high probability of implant survival of between 80% and 100%, whereas late infections generally require prosthesis revision to control the infection [7,22,44,45].…”