The tale of microencapsulated rifampicin: is it useful for the treatment of periprosthetic joint infection?

Abstract

Purpose Microencapsulation techniques have allowed the addition of rifampicin to bone cement, but its in vivo efficacy has not been proven. The aim of our study is to determine the superiority of cement containing gentamicin and rifampicin microcapsules in the treatment of PJI versus cement exclusively containing gentamicin. Methods An S. aureus PJI was induced in 15 NZW rabbits. A week after inoculation, the first stage of replacement was carried out, and the animals were divided into two groups: group R received a spacer containing gentamicin and rifampicin microcapsules, and group C received a spacer containing gentamicin. Intra-articular release curve of rifampicin and infection and toxicity markers were monitored for four weeks post-operatively, when microbiological analysis was performed. Results The microbiological cultures showed a significantly lower growth of S. aureus in soft tissue (2.3·104 vs 0; p = 0.01) and bone (5.7·102 vs 0; p = 0.03) in the group with rifampicin microcapsules. No differences were found in systemic toxicity markers. Rifampicin release from the cement spacer showed higher concentrations than the staphylococcal MIC throughout the analysis. Conclusion The in vivo analyses demonstrated the superiority of cement containing gentamicin and rifampicin microcapsules versus the isolated use of gentamicin in the treatment of PJI in the rabbit model without serious side effects due to the systemic absorption of rifampicin. Given the increasing incidence of staphylococci-related PJI, the development of new strategies for intra-articular administration of rifampicin for its treatment has a high clinical impact.

Determination of the Elution Capacity of Dalbavancin in Bone Cements: New Alternative for the Treatment of Biofilm-Related Peri-Prosthetic Joint Infections Based on an In Vitro Study

“…PJI is one of the most relevant complications in orthopedic surgery [ 3 ], which is well known to be a biofilm-related infection [ 36 , 37 ]. The use of local antibiotics is one of the recommended approaches to treat PJI, antibiotic-loaded bone cements being the most widely used [ 8 , 38 , 39 , 40 , 41 ] and, in particular, dual-antibiotic high-loaded bone cements are more effective and cost efficient than single ones for the prevention of PJI [ 33 ]. One of the most used antibiotics is vancomycin, which has shown a suitable elution capacity and antimicrobial activity in several studies [ 42 , 43 , 44 ].…”

Do High Doses of Multiple Antibiotics Loaded into Bone Cement Spacers Improve the Success Rate in Staphylococcal Periprosthetic Joint Infection When Rifampicin Cannot Be Employed?

“…The use of local antibiotics is one of the recommended approaches to treat PJI, with antibiotic-loaded bone cement being the most widely used [ 15 , 16 , 17 ]. In particular, dual-antibiotic-loaded bone cement (vancomycin + aminoglycoside) has been found to be more effective and cost-efficient than single antibiotics for the treatment of PJI [ 18 ].…”