Comment on “Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France”  by Becker et al. (2020)

Scheper, Henk; Boer, Mark G J de

doi:10.5194/jbji-6-17-2020

Cited by 6 publications

(6 citation statements)

References 1 publication

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“…Unfortunately, the study was underpowered to draw definitive conclusions, and in addition, rifampin was not combined with a fluoroquinolone or other agents active against biofilms, nor with antibiotics with adequate oral availability and bone penetration. The clear benefit of rifampin demonstrated in observational studies has been criticized because of confounding by indication and survival bias [ 8 , 14 , 15 ]. However, in our study, subanalyses in which confounding and bias were reduced to a minimum did not change the results, and consistently supported the use of rifampin in acute staphylococcal PJIs managed with DAIR.…”

Section: Discussionmentioning

confidence: 99%

If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study

Beldman

Löwik

Soriano

et al. 2021

Clinical Infectious Diseases

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Background Rifampin is generally advised in the treatment of acute staphylococcal periprosthetic joint infections (PJI). However, if, when, and how to use rifampinremains a matter of debate. We evaluated the outcome of patients treated with and without rifampin, and analyzed the influence of timing, dose and co-antibiotic. Methods Acute staphylococcal PJIs treated with surgical debridement between 1999 and 2017, and a minimal follow-up of 1 year were evaluated. Treatment failure was defined as the need for any further surgical procedure related to infection, PJI-related death or the need for suppressive antimicrobial treatment. Results A total of 669 patients were analyzed. Treatment failure was 32.2% (131/407) in patients treated with rifampin and 54.2% (142/262) in whom rifampin was withheld (P < 0.001). The most prominent effect of rifampin was observed in knees (treatment failure 28.6% versus 63.9%, respectively, P < 0.001). The use of rifampin was an independent predictor of treatment success in the multi-variate analysis (OR 0.30, 95% CI 0.20 – 0.45). In the rifampin group, the use of a co-antibiotic other than a fluoroquinolone or clindamycin (OR 10.1, 95% CI 5.65 – 18.2) and the start of rifampin within 5 days after surgical debridement (OR 1.96, 95% CI 1.08 – 3.65) were predictors of treatment failure. The dosing of rifampin had no effect on outcome. Conclusions Our data supports the use of rifampin in acute staphylococcal PJIs treated with surgical debridement, particularly in knees. Immediate start of rifampin after surgical debridement should probably be discouraged, but requires further investigation.

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Section: Discussionmentioning

confidence: 99%

If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study

Beldman

Löwik

Soriano

et al. 2021

Clinical Infectious Diseases

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“…In 3 studies, survival bias could be ruled out by excluding patients who failed early after debridement and before start of rifampicin [ 2 , 20 , 21 ], but survival bias was likely present in more studies. The positive association between duration of rifampicin and success rates after DAIR in the study of Becker et al [ 27 ] could be explained by survival bias and selectively excluding patients from the analysis who developed a failure while on rifampicin treatment [ 28 ]. Lora-Tamayo et al [ 2 ] described the strongest association between rifampicin use and outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment duration was 3 months in most studies included in this review. In some observational studies, shorter rifampicin treatment was associated with more treatment failure, but these results should be interpreted cautiously because studying treatment duration in observational studies is inherently affected by selection bias and survival bias [ 12 , 27 , 28 ]. More research is needed to gain more evidence regarding the timing and duration of rifampicin.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis

Scheper

Gerritsen

Pijls

et al. 2021

Open Forum Infectious Diseases

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The treatment of staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics and retention of the implant (DAIR) often results in failure. An important evidence gap concerns the treatment with rifampicin for PJI. A systematic review and meta-analysis were conducted to assess the outcome of staphylococcal hip and/or knee PJI after DAIR, focused on the role of rifampicin. Studies published until September 2nd, 2020 were included. Success rates were stratified for type of joint and type of micro-organism. Sixty-four studies were included. The pooled risk ratio for rifampicin effectiveness was 1.10 (95% CI 1.00-1.22). Pooled success rate was 69% for S. aureus hip PJI, 54% for S. aureus knee PJI, 83% for CNS hip PJI and 73% for CNS knee PJI. Success rates for MRSA PJI (58%) were similar to MSSA PJI (60%). The meta-analysis indicates that rifampicin may only prevent a small fraction of all treatment failures.

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“…Treatment duration was 3 months in most studies included in this review. In some observational studies, shorter rifampicin treatment was associated with more treatment failure, but these results should be interpreted cautiously because studying treatment duration in observational studies is inherently affected by selection bias and survival bias [12,27,28]. More research is needed to gain more evidence regarding the timing and duration of rifampicin.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Debridement, Antibiotics and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis

Scheper,

Gerritsen,

Pijls

et al. 2021

SSRN Journal

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Comment on “Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France” by Becker et al. (2020)

Cited by 6 publications

References 1 publication

If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study

If, When, and How to Use Rifampin in Acute Staphylococcal Periprosthetic Joint Infections, a Multicentre Observational Study

Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis

Outcome of Debridement, Antibiotics and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis

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