Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study

Abstract

BackgroundStaphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.MethodsIn this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months.Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.ResultsIn this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.ConclusionCombined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection

“…One possible explanation is that staphylococcus more easily forms a biofilm on the surface of the implants, as well as its drug‐resistance to antibiotics . Novel materials, such as α‐tocopheryl acetate and α‐tocopheryl phosphate, have been observed to be able to prevent biofilm formation by Staphylococcus aureus , which is encouraging, as these materials may act as promising tools to be incorporated into the DAIR procedure. For streptococcal infections, our limited data demonstrated a generally satisfactory success rate of 71.4% (5/7 cases), which was still higher than the data from a multicenter study (35%, 11/31 cases).…”

“…All 3 cases with Staphylococcus aureus infections were successfully treated, and even for methicillin‐resistant staphylococcus, as was observed in our 9 MRSE infections, the use of DAIR completely eradicated the infections. These data were similar to those in a report by Leijtens et al ., which demonstrated a 78% success rate (14/18 cases) for acute staphylococcal PJI . Staphylococcal infections have been viewed as being a risk factor for failed DAIR, as the literature has reported a high failure rate, ranging from 45% to 76% (Table ).…”

Minimum inhibitory concentration and killing properties of rifampicin against canine Staphylococcus pseudintermedius isolates from dogs in the southeast USA

“…Studies have demonstrated that clinical resistance of certain organisms develops more rapidly to RFP compared to many other drugs . As such, recommendations for RFP use are always accompanied by the admonition of combination, not sole, therapy.…”

Role of Rifampin against Staphylococcal Biofilm Infections In Vitro , in Animal Models, and in Orthopedic-Device-Related Infections

“…However, in these cases, rifampin should not be administered. In several observational studies over the following years, the success rate in patients with PJI treated with a defined duration of rifampin combination therapy ranged between 55% and 100% (61,64,66,(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84). This wide range still triggers the discussion on the divergence of outcome results.…”

“…Thus, other oral combination partners such as trimethoprim-sulfamethoxazole, clindamycin, minocycline, linezolid, and fusidic acid have been proposed. In a retrospective study, 18 patients with PJI treated with DAIR and a clindamycin/rifampin combination had a cure rate of 78% (82). Tornero et al (73) showed a lower success rate with the addition of an antibiotic whose level is decreased by rifampin interaction (linezolid, trimethoprim-sulfamethoxazole, or clindamycin) compared to that of the fluoroquinolone combination, with remission in 13 of 21 patients (61.9% remission) versus 49 of 54 patients (90.7% remission).…”