Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study

Abstract

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3–75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80–58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08–105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.

Cutibacterium acnes Prosthetic Joint Infections: Is Rifampicin-Combination Therapy Beneficial?

“…Our cohort was clinically and microbiologically homogeneous, and in terms of surgical strategy, as we included only monomicrobial Ca-PJIs managed with exchange arthroplasty. Our patients’ characteristics were similar to those of previous studies [ 25 , 26 , 27 , 28 ]: mostly males, median age ~70 years and few comorbidities other than diabetes. PJIs were mainly chronic post-operative infections.…”

“…Rifampicin is not recommended to treat streptococcal, enterococcal or for Ca-PJIs [ 17 , 18 ]. However, the question of the benefit of combination therapy with rifampicin remains [ 25 , 26 , 27 , 28 ]. It was recently analyzed by Kusejko et al in a large retrospective multicenter study on the outcomes of Cutibacterium PJIs [ 28 ]; they observed suggestive, but not statistically significant, evidence of a beneficial effect of rifampicin adjunction to the antibiotic regimen.…”

“…Ca-PJI treatment usually has a good success rate (80–87%) [ 25 , 27 , 28 ]. Our results confirmed that finding with a high two-year reinfection-free rate of 91.3%, and no PJI relapses or related deaths.…”

“…Rifampicin efficacy against C. acnes biofilm has been studied in vitro and in an experimental foreign-body infection model; its efficacy was excellent, showing superiority over all other antibiotics [ 24 ]. However, three clinical studies on 128 patients with Ca-PJIs found no difference in success rates between patients treated with rifampicin or without [ 25 , 26 , 27 ]. More recently, based on a large clinical retrospective multicenter study including 187 patients with Ca-PJIs, Kusejko et al [ 28 ] concluded that rifampicin-combination therapy was not markedly superior for the treatment of these infections.…”

Biofilm-Related Infections in Gram-Positive Bacteria and the Potential Role of the Long-Acting Agent Dalbavancin

“…In in vitro and animal models, rifampicin showed activity also against biofilm formed by Cutibacterium acnes (Furustrand Tafin et al, 2012). However, in a recent study on PJI caused by C. acnes, rifampicin therapy did not seem to improve outcomes, suggesting the need for additional studies on humans (Vilchez et al, 2021).…”