Role of Rifampin for Treatment of Orthopedic Implant–Related Staphylococcal Infections <SUBTITLE>A Randomized Controlled Trial</SUBTITLE>

Abstract

for the Foreign-Body Infection (FBI) Study GroupContext.-Rifampin-containing regimens are able to cure staphylococcal implant-related infections based on in vitro and in vivo observations. However, this evidence has not been proven by a controlled clinical trial.Objective.-To evaluate the clinical efficacy of a rifampin combination in staphylococcal infections associated with stable orthopedic devices.Design.-A randomized, placebo-controlled, double-blind trial conducted from 1992 through 1997.Setting.-Two infectious disease services in tertiary care centers in collaboration with 5 orthopedic surgeons in Switzerland.Patients.-A total of 33 patients with culture-proven staphylococcal infection associated with stable orthopedic implants and with a short duration of symptoms of infection (exclusion limit Ͻ1 year; actual experience 0-21 days).Intervention.-Initial debridement and 2-week intravenous course of flucloxacillin or vancomycin with rifampin or placebo, followed by either ciprofloxacinrifampin or ciprofloxacin-placebo long-term therapy.Main Outcome Measures.-Cure was defined as (1) lack of clinical signs and symptoms of infection, (2) C-reactive protein level less than 5 mg/L, and (3) absence of radiological signs of loosening or infection at the final follow-up visit at 24 months. Failure was defined as (1) persisting clinical and/or laboratory signs of infection or (2) persisting or new isolation of the initial microorganism.Results.-A total of 18 patients were allocated to ciprofloxacin-rifampin and 15 patients to the ciprofloxacin-placebo combination. Twenty-four patients fully completed the trial with a follow-up of 35 and 33 months. The cure rate was 12 (100%) of 12 in the ciprofloxacin-rifampin group compared with 7 (58%) of 12 in the ciprofloxacin-placebo group (P=.02). Nine of 33 patients dropped out due to adverse events (n=6), noncompliance (n=1), or protocol violation (n=2). Seven of the 9 patients who dropped out were subsequently treated with rifampin combinations, and 5 of them were cured without removal of the device.Conclusion.-Among patients with stable implants, short duration of infection, and initial debridement, patients able to tolerate long-term (3-6 months) therapy with rifampin-ciprofloxacin experienced cure of the infection without removal of the implant.

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

“…Decision on a suitable antibiotic therapy was made in an interdisciplinary case discussion at the beginning of therapy, according to the detected pathogen and its susceptibility pattern as well as to published recommendations [6,8,25,27].…”

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.…”

Case report: Fistulating periprosthetic Staphylococcus lugdunensis hip infection cured by intra-articular teicoplanin injections

“…Curative treatment of infections in totally replaced hips without removal of the implant is occasionally reported in patients with a short history of infection and stable implants (Crockarell et al 1998, Zimmerli et al 1998. We had an unusual case of a long-standing infection adjacent to an uncemented hip prosthesis cured by repeated intra-articular injections of teicoplanin in combination with oral antibiotics.…”