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Factors associated with rifampin resistance in staphylococcal periprosthetic joint infections (PJI): a matched case-control study

Achermann, Y. ; Eigenmann, K. ; Ledergerber, B. ; Derksen, L. ; Rafeiner, P. ; Clauss, M. ; Nüesch, R. ; Zellweger, C. ; Vogt, M. ; Zimmerli, W.

In: Infection, 2013, vol. 41, no. 2, p. 431-437

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    Title
    • Factors associated with rifampin resistance in staphylococcal periprosthetic joint infections (PJI): a matched case-control study
    Author
    • Achermann, Y.. University and University Hospital Zurich, Zurich, Switzerland
    • Eigenmann, K.. Cantonal Hospital Zug, Baar, Switzerland
    • Ledergerber, B.. University and University Hospital Zurich, Zurich, Switzerland
    • Derksen, L.. Basel University Medical Clinic, Rheinstrasse 26, 4410, Liestal, Switzerland
    • Rafeiner, P.. Cantonal Hospital St. Gallen, St. Gallen, Switzerland
    • Clauss, M.. Clinic of Orthopedic Surgery, Liestal, Switzerland
    • Nüesch, R.. Clinic Hirslanden, St. Anna Lucerne, Switzerland
    • Zellweger, C.. Clinic Hirslanden Beau-Site, Bern, Switzerland
    • Vogt, M.. Cantonal Hospital Zug, Baar, Switzerland
    • Zimmerli, W.. Basel University Medical Clinic, Rheinstrasse 26, 4410, Liestal, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:313207
    Summary
    Purpose: Rifampin combination therapy plays an important role in the management of staphylococcal periprosthetic joint infection (PJI). However, the emergence of rifampin resistance is a feared complication. We retrospectively analysed predetermined potential risk factors in patients with rifampin-resistant staphylococcal PJI in a multicentre case-control study. Methods: Cases (n=48) were defined as PJI caused by rifampin-resistant staphylococci. Rifampin-susceptible controls (n=48) were matched for microorganism and type of prosthetic joint. Uni- and multivariable conditional logistic regression analyses were performed to estimate odds ratios (OR) with 95% confidence intervals (95% CI). Results: Forty-eight cases (31 men; median age 67years; age range 39-88years) with hip- (n=29), knee- (n=13), elbow- (n=4), shoulder- (n=1) or ankle-PJI (n=1) were enrolled in the study. Staphylococcus aureus and coagulase-negative staphylococci were isolated in ten and 38 episodes, respectively. Most of the cases (n=44, 92%) had a previous PJI, and 93 % (n=41) of these had been treated with rifampin. There was an independent association of emergence of rifampin resistance with male sex (OR 3.6, 95% CI 1.2-11),≥3 previous surgical revisions (OR 4.7, 95% CI 1.6-14.2), PJI treatment with high initial bacterial load (inadequate surgical debridement, <2weeks of intravenous treatment of the combination medication; OR 4.9, 95% CI 1.6-15) and inadequate rifampin therapy (OR 5.4, 95% CI 1.2-25). Conclusions: Based on our results, extensive surgical debridement and adequate antibiotic therapy are needed to prevent the emergence of rifampin resistance