Wednesday, September 19, 2012
Factors associated with rifampin resistance in staphylococcal periprosthetic joint infections (PJI): a matched case-control study
Factors associated with rifampin resistance in staphylococcal periprosthetic joint infections (PJI): a matched case-control study.
Sept 2012
Achermann Y, Eigenmann K, Ledergerber B, Derksen L, Rafeiner P, Clauss M, Nüesch R, Zellweger C, Vogt M, Zimmerli W.
Source
University and University Hospital Zurich, Zurich, Switzerland.
Abstract
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 67 years; age range 39-88 years) 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, 2 weeks of intravenous treatment of the combination medication, and inadequate rifampin therapy
CONCLUSIONS:
Based on our results, extensive surgical debridement and adequate antibiotic therapy are needed to prevent the emergence of rifampin resistance.
Labels: bacterial load, joint infections, prosthetic joint, rifampin, rifampin-resistant staphylococcal PJI
# posted by Pat O'Connor @ 8:49 AM 
