Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study.

June 20, 2017 at 7:11 pm

BMC Infect Dis. May 2, 2017 V.17 N.1 P.321.

Leijtens B1, Elbers JBW2, Sturm PD3, Kullberg BJ4, Schreurs BW2.

Author information

1 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. borg.leijtens@radboudumc.nl.

2 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

3 Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

4 Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.

METHODS:

In this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months. Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.

RESULTS:

In this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.

CONCLUSION:

Combined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414295/pdf/12879_2017_Article_2429.pdf

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Entry filed under: Antimicrobianos, Bacterias, Desinfection and Sterilization, Epidemiología, FIEBRE en el POSTOPERATORIO, Health Care-Associated Infections, Infecciones nosocomiales, Infecciones osteo-articulares-musculares, Infecciones relacionadas a prótesis, Infecciones sitio quirurgico, Metodos diagnosticos, Profilaxis Antibiótica en Cirugía - PAC, REPORTS, Resistencia bacteriana, Sepsis, Update.

Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections. Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis.


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