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

  • Clinical and Epidemiological Study
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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; 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.

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Acknowledgements

We acknowledge the teams of the Division of Infectious Diseases and the Service of Orthopedic Surgery of the CHUV/Lausanne Switzerland for providing data of 2 patients in this study. This work was supported by an unrestricted grant of the Hans-Paul Wälchli Foundation for Research (Lugano, Switzerland).

Conflict of interest

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Authors and Affiliations

  1. University and University Hospital Zurich, Zurich, Switzerland

    Y. Achermann & B. Ledergerber

  2. Cantonal Hospital Zug, Baar, Switzerland

    Y. Achermann, K. Eigenmann & M. Vogt

  3. Orthopedic Clinic Schulthess, Zurich, Switzerland

    M. Vogt

  4. Basel University Medical Clinic, Rheinstrasse 26, 4410, Liestal, Switzerland

    L. Derksen & W. Zimmerli

  5. Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    P. Rafeiner

  6. Clinic of Orthopedic Surgery, Liestal, Switzerland

    M. Clauss

  7. Clinic Hirslanden Beau-Site, Bern, Switzerland

    C. Zellweger

  8. Clinic Hirslanden, St. Anna Lucerne, Switzerland

    R. Nüesch

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  1. Y. Achermann
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  2. K. Eigenmann
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  3. B. Ledergerber
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  8. C. Zellweger
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  10. W. Zimmerli
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Corresponding author

Correspondence to W. Zimmerli.

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Achermann, Y., Eigenmann, K., Ledergerber, B. et al. Factors associated with rifampin resistance in staphylococcal periprosthetic joint infections (PJI): a matched case–control study. Infection 41, 431–437 (2013). https://doi.org/10.1007/s15010-012-0325-7

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  • DOI: https://doi.org/10.1007/s15010-012-0325-7

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