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

Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes

“…This notion of an ongoing natural selection of more hostile CoNS is further supported by previously unexpected findings concerning the non-inferiority of MRSA outcomes when compared to CoNS sequelae in a small series of PJIs in contemporary literature [47,55,56]. This is in contrast to prior literature that found a greater incidence of treatment susceptibility in CoNS, such as Staphylococcus epidermidis, than in MRSA [26,57,58]. Whereas pathogens such as MRSA have been traditionally feared as treatment resistant, with investigators recommending early and more invasive and aggressive intervention [38], the tendency toward rapid biofilm formation and antibiotic resistance acquisition in CoNS makes their behavior in the PJI setting fairly similar at present [55,56].…”

“…Because rifampin susceptibility is not regularly tested at our institution, it is unclear whether this is due to coexisting rifampin resistance, virility of infecting organisms, case complexity, and/or the result of an underpowered sub-analysis. Although our data demonstrates negative results for rifampin usage in adjunct treatment of CoNS PJI, this is the first study to report outcomes after rifampin utilization [26] in these patients and is still limited in power. Future multicenter trials will need to be performed to explore this question further.…”

“…With a one-year treatment failure rate of ~60% after DAIR, our results suggest the likelihood that CoNS patients are at higher risk than traditionally perceived, and prognosis with DAIR is significantly worse than in classic literature. That is, the most recent pooled data for CoNS knee PJI successfully treated with DAIR has been reported as ~73%, with a significant variance across cohort sizes and success rates ranging from 23% to 90% [26]. As in MRSA [59], more aggressive surgical intervention with component removal regardless of symptom duration may provide more effective infection clearance.…”

“…Consequent to the above data, we hypothesized that our results of treatment of PJI of the knee secondary to CoNS bacteria could be worse than our results of treatment of knee PJI secondary to S. aureus, which reports pooled success rates of ~54% [26]. The goal of this study was to characterize the clinical characteristics, treatment outcomes, implant survivorship, and complications related to the treatment of CoNS PJI in the largest known and most comprehensive cohort to date.…”

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

“…Subsequent studies of adjunctive rifampin for staphylococcal PJI following DAIR have inconsistently indicated benefit, including a second RCT of 48 patients in which adding rifampin to glycopeptide or beta-lactam monotherapy did not improve cure [ 3 ]. A recent systematic review suggested that rifampin might marginally enhance cure in PJI following DAIR (relative risk [RR], 1.1; 95% CI, 1.00–1.22) [ 4 ]. However, the authors also found evidence of publication bias, which trim-and-fill analysis suggested may account for rifampin's perceived benefit (adjusted RR, 1.04; 95% CI, 0.94–1.14).…”