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Cortes-Penfield N, Krsak M, Damioli L, Henry M, Seidelman J, Hewlett A, Certain L. How We Approach Suppressive Antibiotic Therapy Following Debridement, Antibiotics, and Implant Retention for Prosthetic Joint Infection. Clin Infect Dis 2024; 78:188-198. [PMID: 37590953 DOI: 10.1093/cid/ciad484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 08/19/2023] Open
Abstract
The optimal treatment of prosthetic joint infection (PJI) remains uncertain. Patients undergoing debridement, antibiotics, and implant retention (DAIR) receive extended antimicrobial treatment, and some experts leave patients at perceived highest risk of relapse on suppressive antibiotic therapy (SAT). In this narrative review, we synthesize the literature concerning the role of SAT to prevent treatment failure following DAIR, attempting to answer 3 key questions: (1) What factors identify patients at highest risk for treatment failure after DAIR (ie, patients with the greatest potential to benefit from SAT), (2) Does SAT reduce the rate of treatment failure after DAIR, and (3) What are the rates of treatment failure and adverse events necessitating treatment discontinuation in patients receiving SAT? We conclude by proposing risk-benefit stratification criteria to guide use of SAT after DAIR for PJI, informed by the limited available literature.
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Affiliation(s)
- Nicolas Cortes-Penfield
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Martin Krsak
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Damioli
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Henry
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Medicine, Division of Infectious Diseases, Hospital for Special Surgery, New York, New York, USA
| | - Jessica Seidelman
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Angela Hewlett
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura Certain
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
- Department of Internal Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
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Yusuf E, Bramer W, Anas AA. Clinical outcomes of rifampicin combination therapy in implant-associated infections due to staphylococci and streptococci: A systematic review and meta-analysis. Int J Antimicrob Agents 2024; 63:107015. [PMID: 37875179 DOI: 10.1016/j.ijantimicag.2023.107015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/20/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES Adjunctive rifampicin for implant-associated infections is controversial. This study investigated the clinical outcomes of rifampicin combination therapy compared with monotherapy in treating prosthetic joint infection (PJI) or prosthetic valve endocarditis (PVE) due to staphylococci and streptococci. METHODS A systematic search was performed from inception to 13 June 2022 in Embase, MEDLINE, Cochrane and Web of Science to investigate the clinical outcomes of rifampicin combination therapy compared with monotherapy in treating staphylococcal and streptococcal PJI or PVE. Randomised controlled trials (RCTs) and observational studies were included in the systematic review and meta-analysis. RESULTS Fourteen studies were included. A moderate quality of evidence was found in favour of rifampicin in patients with staphylococcal PJI who underwent a debridement, antibiotics and implant retention (DAIR) procedure [odds ratio = 2.49, 95% confidence interval (CI) 1.93-3.23]. Including the two RCTs only, adding rifampicin to the antibiotic regimen after DAIR was also in favour of rifampicin, but this was not statistically significant (risk ratio = 1.27, 95% CI 0.79-2.04; n = 126). Pooling data for patients with staphylococcal PJI who underwent a two-stage procedure showed that adding rifampicin was not associated with therapeutic success. Limited evidence was found for the use of rifampicin for PVE caused by staphylococci. CONCLUSIONS Adding rifampicin in the treatment of staphylococcal PJI treated by DAIR clearly increased the likelihood for therapeutic success. The clinical benefit of adjunctive rifampicin in the treatment of other staphylococci and streptococci implant-associated infections is still unclear.
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Affiliation(s)
- Erlangga Yusuf
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Wichor Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Adam A Anas
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Section of Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Salmons HI, Bettencourt JW, Wyles CC, Osmon DR, Berry DJ, Abdel MP. Irrigation and Debridement With Chronic Antibiotic Suppression for the Management of Acutely Infected Aseptic Revision Total Joint Arthroplasties. J Arthroplasty 2023; 38:2710-2715.e2. [PMID: 37295625 PMCID: PMC10937029 DOI: 10.1016/j.arth.2023.05.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Most data on irrigation and debridement with component retention (IDCR) as a treatment for acute periprosthetic joint infections (PJIs) focuses on primary total joint arthroplasties (TJAs). However, the incidence of PJI is greater after revisions. We investigated the outcomes of IDCR with suppressive antibiotic therapy (SAT) following aseptic revision TJAs. METHODS Through our total joint registry, we identified 45 aseptic revision TJAs (33 hips, 12 knees) performed from 2000 to 2017 that were treated with IDCR for acute PJI. Acute hematogenous PJI was present in 56%. Sixty-four percent of PJIs involved Staphylococcus. All patients were treated with 4 to 6 weeks of intravenous antibiotics with the intention to treat with SAT (89% received SAT). The mean age was 71 years (range, 41 to 90), with 49% being women and a mean body mass index of 30 (range, 16 to 60). The mean follow-up was 7 years (range, 2 to 15). RESULTS The 5-year survivorships free from re-revision for infection and reoperation for infection were 80% and 70%, respectively. Of the 13 reoperations for infection, 46% involved the same species as the initial PJI. The 5-year survivorships free from any revision and any reoperation were 72% and 65%, respectively. The 5-year survivorship free from death was 65%. CONCLUSION At 5 years following IDCR, 80% of implants were free from re-revision for infection. As the penalty for implant removal is often high in revision TJAs, IDCR with SAT is a viable option for acute infection after revision TJAs in select patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Harold I. Salmons
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Jacob W. Bettencourt
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Cody C. Wyles
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Douglas R. Osmon
- Division of Infectious Diseases, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
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Kramer TS, Soriano A, Tedeschi S, Chen AF, Tattevin P, Senneville E, Gomez-Junyent J, Birlutiu V, Petersdorf S, de Brito VD, Gonzalez IS, Belden KA, Wouthuyzen-Bakker M. Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been Exchanged? A Multicenter Observational Cohort Study. Open Forum Infect Dis 2023; 10:ofad491. [PMID: 37901121 PMCID: PMC10604993 DOI: 10.1093/ofid/ofad491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
Background Previous studies demonstrated the efficacy of a rifampicin-based regimen in the treatment of acute staphylococcal periprosthetic joint infections (PJIs) treated with surgical debridement. However, evidence is lacking to support the use of rifampicin in cases where the implant is exchanged during revision. Methods We included all consecutive cases of staphylococcal PJIs treated from January 2013 to December 2018 with revision surgery in this international, retrospective, multicenter observational cohort study. PJI was defined according to the European Bone and Joint Infection Society diagnostic criteria. A relapse or reinfection during follow-up, the need for antibiotic suppressive therapy, the need for implant removal, and PJI-related death were defined as clinical failure. Cases without reimplantation or with follow-up <12 months were excluded. Results A total of 375 cases were included in the final analysis, including 124 1-stage exchanges (33.1%) and 251 2-stage exchanges (66.9%). Of those, 101 cases failed (26.9%). There was no statistically significant difference in failure of patients receiving rifampicin (22.5%, 42/187) and those not receiving rifampicin (31.4%, 59/188; P = .051). A subanalysis of chronic PJIs treated by 2-stage exchange arthroplasty demonstrated a lower failure rate in cases treated with rifampicin (15%) compared with the no-rifampicin group (35.5%; P = .005). In this subgroup, the use of rifampicin and an antibiotic holiday of >2 weeks were independent predictors of clinical success (odds ratio [OR], 0.36; 95% CI, 0.15-0.88; and OR, 0.19; 95% CI, 0.04-0.90; respectively). Conclusions Combination treatment with rifampicin increases treatment success in patients with chronic staphylococcal PJI treated with 2-stage exchange arthroplasty.
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Affiliation(s)
- Tobias Siegfried Kramer
- Institute for Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Clinic for Orthopedic Surgery and Traumatology, Evangelisches Waldkrankenhaus Berlin, Berlin, Deutschland
- LADR der Laborverbund Dr. Kramer & Kollegen, Geesthacht, Germany
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Sarah Tedeschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universistaria di Bologna, Bologna, Italy
| | - Antonia F Chen
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Eric Senneville
- French National Referent Centre for Complex Bone and Joint Infections, CRIOAC Lille-Tourcoing, Lille, France
| | - Joan Gomez-Junyent
- Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Victoria Birlutiu
- County Clinical Emergency Hospital of Sibiu, Faculty of Medicine, Lucian Blaga University of Sibiu, Romania
| | - Sabine Petersdorf
- Institute for Medical Laboratory Diagnostics, Helios University Clinic Wuppertal, Wuppertal, Germany
| | - Vicens Diaz de Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi (Barcelona), Spain
| | - Ignacio Sancho Gonzalez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Navarra, Pamplona, España
| | - Katherine A Belden
- Division of Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Lazarinis S, Hailer NP, Järhult JD, Brüggemann A. Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients. Antibiotics (Basel) 2023; 12:1499. [PMID: 37887200 PMCID: PMC10603907 DOI: 10.3390/antibiotics12101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Rifampicin is a pillar in the treatment of periprosthetic joint infection (PJI). However, rifampicin resistance is an increasing threat to PJI treatment. This study explores the incidence of rifampicin-resistant bacteria over time in a Swedish tertiary referral centre and the association of rifampicin resistance with infection-free survival after PJI. METHODS The study included 238 staphylococcal PJIs treated between 2001 and 2020 for which susceptibility data for rifampicin were available. Data on causative bacteria, rifampicin resistance, treatment, and outcome were obtained. Kaplan-Meier survival analysis and Cox regression modelling estimated the infection-free cumulative survival and adjusted hazard ratios (HRs) for the risk of treatment failure. RESULTS Rifampicin-resistant causative bacteria were identified in 40 cases (17%). The proportion of rifampicin-resistant agents decreased from 24% in 2010-2015 to 12% in 2016-2020. The 2-year infection-free survival rates were 78.6% (95% CI, 66.4-93.1%) for the rifampicin-resistant group and 90.0% (95% CI, 85.8-94.4%) for the rifampicin-sensitive group. Patients with PJI caused by rifampicin-resistant bacteria had an increased risk of treatment failure (adjusted HR, 4.2; 95% CI, 1.7-10.3). CONCLUSIONS The incidence of PJI caused by rifampicin-resistant bacteria did not increase over the past 20 years. The risk of treatment failure in PJI caused by rifampicin-resistant bacteria is more than four times that caused by rifampicin-sensitive bacteria, highlighting the importance of limiting the development of rifampicin resistance.
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Affiliation(s)
- Stergios Lazarinis
- Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, Sweden; (N.P.H.); (A.B.)
| | - Nils P. Hailer
- Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, Sweden; (N.P.H.); (A.B.)
| | - Josef D. Järhult
- Department of Medical Sciences, Zoonosis Science Center, Uppsala University, SE-751 85 Uppsala, Sweden;
| | - Anders Brüggemann
- Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, Sweden; (N.P.H.); (A.B.)
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Wouthuyzen-Bakker M, Scheper H. Rifampicin in periprosthetic joint infections: where do we stand and where are we headed? Expert Rev Anti Infect Ther 2023:1-7. [PMID: 37141111 DOI: 10.1080/14787210.2023.2211263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION A periprosthetic joint infection (PJI) is a major complication of arthroplasty. Treatment of PJI consists of surgical debridement with or without the exchange of the implant and long-term antimicrobial treatment. Rifampicin is regarded as one of the cornerstones of antimicrobial treatment for staphylococcal PJI, but the exact role of rifampicin for PJI in different clinical scenarios remains to be elucidated. AREAS COVERED In this perspective article, an overview is provided of in vitro, in vivo and clinical studies that were the basis of the current guidelines and recommendations for rifampicin use in daily practice for PJI. Controversial issues on indication, dosing, timing, duration and antibiotic drug interactions will be addressed. Finally, the most urgent clinical questions on rifampicin use that need answering in the nearby future will be formulated. EXPERT OPINION Many inquiries remain concerning the exact indications and clinical use of rifampicin in PJI. Randomized controlled trials are needed to answer these questions.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of medical microbiology and infection prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Scheper
- Department of infectious diseases, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
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Lunz A, Omlor GW, Schmidt G, Moradi B, Lehner B, Streit MR. Quality of life, infection control, and complication rates using a novel custom-made articulating hip spacer during two-stage revision for periprosthetic joint infection. Arch Orthop Trauma Surg 2022; 142:4041-4054. [PMID: 34853867 PMCID: PMC9596578 DOI: 10.1007/s00402-021-04274-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Two-stage revision remains the gold standard treatment for most chronically infected and complex total hip arthroplasty infections. To improve patient outcome and reduce complication rates, we have developed a novel custom-made articulating hip spacer technique and present our short-term results. MATERIALS AND METHODS Between November 2017 and November 2019, 27 patients (mean age 70 years) underwent two-stage revision for periprosthetic joint infection of the hip using the articulating spacer design described here. We retrospectively analyzed spacer-related complications as well as rates for complication, infection control, and implant survivorship after final reimplantation. Furthermore, we prospectively collected patient-reported health-related quality of life (HRQoL) scores prior to spacer implantation, with the spacer and after reimplantation of the new prosthesis. RESULTS An additional round of spacer exchange was performed in two patients (8.3%), persistent wound discharge was the reason in both cases. We had one (4.2%) spacer-related mechanical complication, a dislocation that was treated with closed reduction. After reimplantation, infection control was achieved in 96% with an implant survivorship of 92% after a mean follow-up time of 19 (range 7-32, SD 7.2) months. While the scores for VR-12 MCS, VAS hip pain and patient-reported overall satisfaction significantly improved after first stage surgery, the scores for WOMAC, UCLA and VR-12 PCS significantly improved after second stage surgery. CONCLUSIONS Our two-stage approach for periprosthetic joint infection shows high infection eradication and implant survivorship rates at short-term follow-up. Spacer-related complication rates were low, and we achieved high patient satisfaction rates and low pain levels already during the spacer period. To further simplify comparison between different spacer designs, we propose a new hip spacer classification system.
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Affiliation(s)
- Andre Lunz
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Georg W Omlor
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Gunter Schmidt
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Babak Moradi
- Clinic for Orthopedics and Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Burkhard Lehner
- Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
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Sebastian S, Tandberg F, Liu Y, Raina DB, Tägil M, Collin M, Lidgren L. Extended local release and improved bacterial eradication by adding rifampicin to a biphasic ceramic carrier containing gentamicin or vancomycin. Bone Joint Res 2022; 11:787-802. [DOI: 10.1302/2046-3758.1111.bjr-2022-0101.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims There is a lack of biomaterial-based carriers for the local delivery of rifampicin (RIF), one of the cornerstone second defence antibiotics for bone infections. RIF is also known for causing rapid development of antibiotic resistance when given as monotherapy. This in vitro study evaluated a clinically used biphasic calcium sulphate/hydroxyapatite (CaS/HA) biomaterial as a carrier for dual delivery of RIF with vancomycin (VAN) or gentamicin (GEN). Methods The CaS/HA composites containing RIF/GEN/VAN, either alone or in combination, were first prepared and their injectability, setting time, and antibiotic elution profiles were assessed. Using a continuous disk diffusion assay, the antibacterial behaviour of the material was tested on both planktonic and biofilm-embedded forms of standard and clinical strains of Staphylococcus aureus for 28 days. Development of bacterial resistance to RIF was determined by exposing the biofilm-embedded bacteria continuously to released fractions of antibiotics from CaS/HA-antibiotic composites. Results Following the addition of RIF to CaS/HA-VAN/GEN, adequate injectability and setting of the CaS/HA composites were noted. Sustained release of RIF above the minimum inhibitory concentrations of S. aureus was observed until study endpoint (day 35). Only combinations of CaS/HA-VAN/GEN + RIF exhibited antibacterial and antibiofilm effects yielding no viable bacteria at study endpoint. The S. aureus strains developed resistance to RIF when biofilms were subjected to CaS/HA-RIF alone but not with CaS/HA-VAN/GEN + RIF. Conclusion Our in vitro results indicate that biphasic CaS/HA loaded with VAN or GEN could be used as a carrier for RIF for local delivery in clinically demanding bone infections. Cite this article: Bone Joint Res 2022;11(11):787–802.
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Affiliation(s)
- Sujeesh Sebastian
- Department of Clinical Sciences, Orthopedics, Lund University Faculty of Medicine, Lund, Sweden
| | - Felix Tandberg
- Department of Clinical Sciences, Orthopedics, Lund University Faculty of Medicine, Lund, Sweden
| | - Yang Liu
- Department of Clinical Sciences, Orthopedics, Lund University Faculty of Medicine, Lund, Sweden
| | - Deepak B. Raina
- Department of Clinical Sciences, Orthopedics, Lund University Faculty of Medicine, Lund, Sweden
| | - Magnus Tägil
- Department of Clinical Sciences, Orthopedics, Lund University Faculty of Medicine, Lund, Sweden
| | - Mattias Collin
- Division of Infection Medicine, Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences, Orthopedics, Lund University Faculty of Medicine, Lund, Sweden
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Suzuki H, Goto M, Nair R, Livorsi DJ, Sekar P, Ohl ME, Diekema DJ, Perencevich EN, Alexander B, Jones MP, McDaniel JS, Schweizer ML. Effectiveness and Optimal Duration of Adjunctive Rifampin Treatment in the Management of Staphylococcus Aureus Prosthetic Joint Infections after Debridement, Antibiotics and Implant Retention. Open Forum Infect Dis 2022; 9:ofac473. [PMID: 36196299 PMCID: PMC9522668 DOI: 10.1093/ofid/ofac473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Rifampin is recommended as adjunctive therapy for patients with a Staphylococcus aureus prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) with no solid consensus on the optimal duration of therapy. Our study assessed the effectiveness and optimal duration of rifampin for S. aureus PJI using Veterans Health Administration (VHA) data.
Methods
We conducted a retrospective cohort study of patients with S. aureus PJI managed with DAIR between 2003 and 2019 in VHA hospitals. Patients who died within 14 days after DAIR were excluded. The primary outcome was a time to microbiological recurrence from 15 days up to two years after DAIR. Rifampin use was analyzed as a time-varying exposure, and time-dependent hazard ratios (HRs) for recurrence were calculated according to the duration of rifampin treatment.
Results
Among 4,624 patients, 842 (18.2%) received at least one dose of rifampin. 1785 (38.6%) experienced recurrence within two years. Rifampin treatment was associated with significantly lower HRs for recurrence during the first 90 days of treatment (HR 0.60; 95%CI 0.45-0.79) and between days 91 and 180 (HR 0.16; 95%CI 0.04-0.66) but no statistically significant protective effect was observed with longer than 180 days (HR 0.57; 95%CI 0.18-1.81). The benefit of rifampin was observed for subgroups including knee PJI, MSSA or MRSA infection, and early or late PJI.
Conclusions
This study supports current guidelines which recommend adjunctive rifampin use for up to six months among patients with S. aureus PJI treated with DAIR.
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Affiliation(s)
- Hiroyuki Suzuki
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Michihiko Goto
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Rajeshwari Nair
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Daniel J Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Poorani Sekar
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Michael E Ohl
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Eli N Perencevich
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
| | - Bruce Alexander
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
| | - Michael P Jones
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Biostatistics, University of Iowa College of Public Health , Iowa City, IA , USA
| | - Jennifer S McDaniel
- Department of Epidemiology, University of Iowa College of Public Health , Iowa City, IA , USA
| | - Marin L Schweizer
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System , Iowa City, IA , USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine , Iowa City, IA , USA
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Mian HM, Lyons JG, Perrin J, Froehle AW, Krishnamurthy AB. A review of current practices in periprosthetic joint infection debridement and revision arthroplasty. ARTHROPLASTY 2022; 4:31. [PMID: 36045436 PMCID: PMC9434893 DOI: 10.1186/s42836-022-00136-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection remains a significant challenge for arthroplasty surgeons globally. Over the last few decades, there has been much advancement in terms of treatment and diagnosis, however, the fight rages on. As management of periprosthetic joint infections continues to evolve, it is critical to reflect back on current debridement practices to establish common ground as well as identify areas for future research and improvement. BODY: In order to understand the debridement techniques of periprosthetic joint infections, one must also understand how to diagnose a periprosthetic joint infection. Multiple definitions have been elucidated over the years with no single consensus established but rather sets of criteria. Once a diagnosis has been established the decision of debridement method becomes whether to proceed with single vs two-stage revision based on the probability of infection as well as individual patient factors. After much study, two-stage revision has emerged as the gold standard in the management of periprosthetic infections but single-stage remains prominent with further and further research. CONCLUSION Despite decades of data, there is no single treatment algorithm for periprosthetic joint infections and subsequent debridement technique. Our review touches on the goals of debridement while providing a perspective as to diagnosis and the particulars of how intraoperative factors such as intraarticular irrigation can play pivotal roles in infection eradication. By providing a perspective on current debridement practices, we hope to encourage future study and debate on how to address periprosthetic joint infections best.
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Affiliation(s)
- Humza M Mian
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA.
| | - Joseph G Lyons
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
| | - Joshua Perrin
- Wright State University Boonshoft School of Medicine, Wright State Physicians Bldg, 725 University Blvd., Dayton, OH, 45435, USA
| | - Andrew W Froehle
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
- School of Nursing, Kinesiology and Health, Wright State University, 3640 Colonel Glenn Hwy., Dayton, OH, 45435, USA
| | - Anil B Krishnamurthy
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
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11
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The Use of Rifampin in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Comparative Studies. J Arthroplasty 2022; 37:1650-1657. [PMID: 35346810 DOI: 10.1016/j.arth.2022.03.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty (TJA). Rifampin is an antibiotic with the ability to penetrate bacterial biofilms, and thus has been considered as a potentially important adjunct in the prevention and treatment of PJI. The aim of this systematic review is to evaluate and summarize the use of rifampin in TJA, particularly in the context of PJI. METHODS A literature search of all relevant electronic databases was performed. All comparative studies assessing the use of rifampin in the context of TJA were included. Descriptive data are reported, and a meta-analysis was performed using all studies which compared the addition of rifampin to standard care in treating PJI. RESULTS A total of 33 studies met inclusion criteria. A meta-analysis of 22 studies comparing the addition of rifampin to standard care for treating PJI found a significant reduction in failure rates (26.0% vs 35.9%; odds ratio 0.61, 95% confidence interval 0.43-0.86). The protective effect of rifampin was maintained in studies which included exchange arthroplasty as a treatment strategy, but not in studies only using an implant retention strategy. Among studies reporting adverse events of rifampin, there was a 20.5% adverse event rate. CONCLUSION Overall, rifampin appears to confer a protective effect against treatment failure following PJI. This treatment effect is particularly pronounced in the context of exchange arthroplasty. Further high-level evidence is needed to clarify the exact indications and doses of rifampin which can most effectively act as an adjunct in the treatment of PJI. LEVEL OF EVIDENCE Level III, Systematic Review and Meta-Analysis of Level I-III Studies.
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12
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Tai DBG, Berbari EF, Suh GA, Lahr BD, Abdel MP, Tande AJ. Truth in DAIR: Duration of Therapy and the Use of Quinolone/Rifampin-Based Regimens following Debridement and Implant Retention for Periprosthetic Joint Infections. Open Forum Infect Dis 2022; 9:ofac363. [PMID: 36072695 PMCID: PMC9439576 DOI: 10.1093/ofid/ofac363] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background The optimal duration of antibiotic therapy after debridement and implant retention (DAIR) for periprosthetic joint infections (PJIs) is debated. Furthermore, the best antibiotic regimens for staphylococcal PJI are also unclear. In this study, we evaluated the impact of antibiotic therapy duration on the risk of failure. We assessed the utility of rifampin-based regimens for staphylococcal PJI managed with DAIR. Methods We performed a retrospective cohort study of patients 18 years and older diagnosed with hip and knee PJI who underwent DAIR between January 1, 2008 and 31 December 31, 2018 at Mayo Clinic, USA. The outcome was failure of DAIR. For statistical analysis, joint-stratified Cox regression models adjusted for age, sinus tract, symptom duration, and primary/revision arthroplasty were performed. Results We examined 247 cases of PJI with a median follow-up of 4.4 years (interquartile range [IQR], 2.3–7) after DAIR. The estimated 5-year cumulative incidence of failure was 28.1% (n = 65). There was no association between the duration of intravenous (IV) antibiotics (median 42 days; IQR, 38–42) and treatment failure (P = .119). A shorter duration of subsequent oral antibiotic therapy was associated with a higher risk of failure (P = .005; eg, 90-day vs 1-year duration; hazard ratio [HR], 3.50; 95% confidence interval [CI], 1.48–8.25). For staphylococcal knee PJI, both the use and longer duration of a rifampin-based regimen were associated with a lower risk of failure (both P = .025). There was no significant association between fluoroquinolone (FQ) use and failure (HR, 0.62; 95% CI, .31–1.24; P = .172). Conclusions The duration of initial IV antibiotic therapy did not correlate with treatment failure in this cohort of patients. Rifampin use is recommended for staphylococcal knee PJI. There was no apparent benefit of FQ use in staphylococcal PJI.
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Affiliation(s)
- Don Bambino Geno Tai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine , Mayo Clinic , USA
| | - Elie F Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine , Mayo Clinic , USA
| | - Gina A Suh
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine , Mayo Clinic , USA
| | - Brian D Lahr
- Department of Quantitative Health Sciences , Mayo Clinic , USA
| | | | - Aaron J Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine , Mayo Clinic , USA
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13
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Zhang T, Lian X, Chen Y, Cai B, Xu J. Clinical Outcome of Postoperative Surgical Site Infection in Patients with Posterior Thoracolumbar and Lumbar Instrumentation. J Hosp Infect 2022; 128:26-35. [PMID: 35788013 DOI: 10.1016/j.jhin.2022.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Postoperative surgical site infection (SSI) is associated with greater rates of disability, especially in instrumented spinal surgeries. The management of implant-associated surgical site infections (SSI) is challenging. We analyzed the data from our hospital databases to assess the incidence and characteristics related to postoperative surgical site infection (SSI) after posterior thoracolumbar and lumbar instrumentation. METHODS Patient demographics, infection characteristics, details of treatment, and perioperative factors were reviewed (Jan 2010 to Dec 2020). The Oswestry disability index (ODI), Patient Health Questionnaire-9 (PHQ-9), and Visual Analog Scale (VAS) scores for back and leg pain were analyzed preoperatively and postoperatively until last follow-up. RESULTS Of the 27,881 procedures collected from the databases, 521 were diagnosed with SSI (1.8%), and 191(36.7%) received at least one revision surgery for SSI. Infection rate was significantly higher in patients with lumbar spinal stenosis than those with scoliosis or kyphosis (P<0.01). Methicillin-sensitive Staphylococcus aureus (43.4%) was the most commonly isolated pathogen. The rate of complication secondary to antibiotics treatment was 7.8%, and long-term antibiotic suppression was reported in 15.2% of patients. Instrumentation was retained in 175 patients (91.6%) and all SSIs were controlled without recurrence during the follow-up. CONCLUSION Analysis of 27,881 patients showed an average SSI rate of 1.8%. Patients with deep wound SSI can be successfully treated in most cases with retention of instrumentation. Early diagnosis, positive revision surgery with strict irrigation, thorough debridement, and a long-term course of antibiotics are critical for eradicating infection, retaining implants, decreasing morbidity, and achieving wound healing.
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Affiliation(s)
- Tao Zhang
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
| | - Xiaofeng Lian
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
| | - Yuanyuan Chen
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China.
| | - Bin Cai
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
| | - Jianguang Xu
- Orthopaedic department, Shanghai sixth people's hospital, Shanghai Jiaotong University Affiliated, 600 Yishan Rd, Shanghai, China
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14
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Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes. J Arthroplasty 2022; 37:S313-S320. [PMID: 35196567 DOI: 10.1016/j.arth.2022.02.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Coagulase-negative staphylococci (CoNS) are biofilm-producing pathogens whose role in periprosthetic joint infection (PJI) is increasing. There is little data on the prognosis and treatment considerations in the setting of PJI. We sought to evaluate the clinical characteristics, outcomes, and complications in these patients. METHODS This is a retrospective cohort study of adult patients at a single tertiary medical center from 2009 to 2020 with culture-proven CoNS PJI after total knee arthroplasty, as diagnosed by Musculoskeletal Infection Society criteria. The primary outcome was treatment success, with failure defined as recurrent CoNS PJI, recurrent PJI with a new pathogen, and/or chronic oral antibiotic suppression at one year postoperatively. RESULTS We identified 55 patients with a CoNS total knee arthroplasty PJI with a mean follow-up of 29.8 months (SD: 16.3 months). The most commonly isolated organism was Staphylococcus epidermidis (n = 36, 65.5%). The overall prevalence of methicillin resistance was 63%. Surgical treatment included surgical debridement, antibiotics, and implant retention in 25 (45.5%) cases and two-stage revision (22 articulating and eight static antibiotic-impregnated spacers). At one-year follow-up, only 47% of patients had successful management of their infection. The surgical debridement, antibiotics, and implant retention cohort had the higher rate of treatment failure (60.0%) compared to two-stage revision (46.7%). CONCLUSION These results indicate a poor rate of success in treating CoNS PJI. This likely represents the interplay of inherent virulence through biofilm formation and decreased antibiotic efficacy.
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15
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Bernaus M, Auñón-Rubio Á, Monfort-Mira M, Arteagoitia-Colino I, Martínez-Ros J, Castellanos J, Lamo-Espinosa JM, Argüelles F, Veloso M, Gómez García L, Crespo FA, Sánchez-Fernández J, Murias-Álvarez J, Martí-Garín D, Hernández-González N, Villarejo-Fernández B, Valero-Cifuentes G, Hernández-Torres A, Molina-González J, Coifman-Lucena I, Esteban-Moreno J, Demaria P, Esteve-Palau E, Del Pozo JL, Suárez Á, Carmona-Torre F, Darás Á, Baeza J, Font-Vizcarra L. Risk Factors of DAIR Failure and Validation of the KLIC Score: A Multicenter Study of Four Hundred Fifty-Five Patients. Surg Infect (Larchmt) 2022; 23:280-287. [PMID: 35172116 DOI: 10.1089/sur.2021.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Debridement, antibiotic agents, and implant retention (DAIR) is a currently accepted approach for the treatment of early prosthetic joint infections (PJI). The success of a DAIR procedure has shown variable results throughout the published literature. Scoring systems such as the Kidney, Liver, Index surgery, Cemented prosthesis, and C-reactive protein value (KLIC) score for the selection of patients that are likely to benefit from DAIR have proved to be helpful in decision making. Our study aims to further validate the KLIC score using a large external multicentric cohort and to evaluate other risk factors for failure. Patients and Methods: A retrospective analysis of patients with an early acute PJI who were treated with DAIR and recorded in a database of eight Spanish university hospitals was performed. According to pre-operative variables of the KLIC study, patients were categorized into five groups: group A, ≤2 points; group B, 2.5-3.5 points; group C, 4-5 points; group D, 5.5-6.5 points; and group E, ≥7 points. Failure rates were compared between groups at 60 days and after 60 days of DAIR. Further variables for risk of failure were also analyzed. Results: A total of 455 patients with early acute PJI were included in the analyses. At 60 days, patients presenting with pre-operative elevated C-reactive protein serum levels, Staphylococcus aureus, and polymicrobial infections were associated with failure. Failure rates recorded were 12% for group A (n = 210), 18% for group B (n = 83), 26% for group C (n = 89), 24% for group D (n = 66), and 0% for group E (n = 7). Univariable analysis between consecutive groups of the KLIC score showed no differences for failure before 60 days of the DAIR procedure. Scheduled surgery and having the procedure performed by a specialized unit were also identified as important factors for DAIR success. Conclusions: Our results suggest the KLIC score was not useful for predicting failure in our cohort. Furthermore, our results indicate a specialized unit should conduct DAIR procedures.
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Affiliation(s)
- Martí Bernaus
- Department of Orthopedics and Traumatology, Osteoarticular Infection Unit, Hospital Universitari Mutua Terrassa, Barcelona, Spain
| | - Álvaro Auñón-Rubio
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Montserrat Monfort-Mira
- Septic Unit, Orthopedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Javier Martínez-Ros
- Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan Castellanos
- Department of Orthopedics and Traumatology, Hospital General del Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Francisco Argüelles
- Department of Orthopedics and Traumatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Margarita Veloso
- Department of Orthopedics and Traumatology, Osteoarticular Infection Unit, Hospital Universitari Mutua Terrassa, Barcelona, Spain
| | - Lucia Gómez García
- Department of Infectious Diseases, Osteoarticular Infection Unit, Hospital Universitari Mutua Terrassa, Barcelona, Spain
| | - Francesc Anglès Crespo
- Department of Orthopedics and Traumatology, Osteoarticular Infection Unit, Hospital Universitari Mutua Terrassa, Barcelona, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Joel Sánchez-Fernández
- Septic Unit, Orthopedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Juan Murias-Álvarez
- Septic Unit, Orthopedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - David Martí-Garín
- Septic Unit, Orthopedic Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | | | - Gregorio Valero-Cifuentes
- Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Alícia Hernández-Torres
- Osteoarticular Infection Unit, Department of Infectious Diseases, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José Molina-González
- Osteoarticular Infection Unit, Department of Orthopedics and Traumatology, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ismael Coifman-Lucena
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jaime Esteban-Moreno
- Department of Microbiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Pablo Demaria
- Department of Orthopedics and Traumatology, Hospital General del Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Erika Esteve-Palau
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
| | - José Luis Del Pozo
- Department of Infectious Diseases, Clínica Universidad de Navarra, Pamplona, Spain
| | - Álvaro Suárez
- Department of Orthopedics and Traumatology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Álvaro Darás
- Department of Orthopedics and Traumatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Baeza
- Department of Orthopedics and Traumatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Lluís Font-Vizcarra
- Department of Orthopedics and Traumatology, Osteoarticular Infection Unit, Hospital Universitari Mutua Terrassa, Barcelona, Spain
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16
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Marro FC, Abad L, Blocker AJ, Laurent F, Josse J, Valour F. In vitro antibiotic activity against intraosteoblastic Staphylococcus aureus: a narrative review of the literature. J Antimicrob Chemother 2021; 76:3091-3102. [PMID: 34459881 PMCID: PMC8598303 DOI: 10.1093/jac/dkab301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Staphylococcus aureus – a major aetiological agent of bone and joint infection (BJI) – is associated with a high risk of relapse and chronicity, in part due to its ability to invade and persist in non-professional phagocytic bone cells such as osteoblasts. This intracellular reservoir protects S. aureus from the action of the immune system and most antibiotics. To date, the choice of antimicrobial strategies for BJI treatment mostly relies on standard susceptibility testing, bone penetration of antibiotics and their ‘antibiofilm’ activity. Despite the role of intracellular persistent S. aureus in the development of chronic infection, the ability of antibiotics to target the S. aureus intraosteoblastic reservoir is not considered in therapeutic choices but might represent a key determinant of treatment outcome. This review provides an overview of the intracellular pharmacokinetics of antistaphylococcal drugs used in the treatment of BJI and of their ability to target intraosteoblastic S. aureus. Thirteen studies focusing on the intraosteoblastic activity of antibiotics against S. aureus were reviewed, all relying on in vitro models of osteoblast infection. Despite varying incubation times, multiplicities of infection, bacterial strains, and the types of infected cell lines, rifamycins and fluoroquinolones remain the two most potent antimicrobial classes for intraosteoblastic S. aureus eradication, consistent with clinical data showing a superiority of this combination therapy in S. aureus orthopaedic device-related infections.
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Affiliation(s)
- Florian C Marro
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France.,Evotec ID Lyon, In Vitro Biology, Infectious Diseases and Antibacterials Unit, Gerland, 69007 Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Lélia Abad
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire de bactériologie, Institut des Agents Infectieux, French National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - Ariel J Blocker
- Evotec ID Lyon, In Vitro Biology, Infectious Diseases and Antibacterials Unit, Gerland, 69007 Lyon, France
| | - Frédéric Laurent
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire de bactériologie, Institut des Agents Infectieux, French National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France.,Centre de Référence pour la prise en charge des Infections ostéo-articulaires complexes (CRIOAc) Lyon, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Josse
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence pour la prise en charge des Infections ostéo-articulaires complexes (CRIOAc) Lyon, Hospices Civils de Lyon, Lyon, France
| | - Florent Valour
- CIRI-Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre de Référence pour la prise en charge des Infections ostéo-articulaires complexes (CRIOAc) Lyon, Hospices Civils de Lyon, Lyon, France.,Service des maladies infectieuses et tropicales, Hospices Civils de Lyon, Lyon, France
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17
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Delayed Rifampin Administration in the Antibiotic Treatment of Periprosthetic Joint Infections Significantly Reduces the Emergence of Rifampin Resistance. Antibiotics (Basel) 2021; 10:antibiotics10091139. [PMID: 34572721 PMCID: PMC8469909 DOI: 10.3390/antibiotics10091139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 11/16/2022] Open
Abstract
Rifampin is one of the most important biofilm-active antibiotics in the treatment of periprosthetic joint infection (PJI), and antibiotic regimens not involving rifampin were shown to have higher failure rates. Therefore, an emerging rifampin resistance can have a devastating effect on the outcome of PJI. The aim of this study was to compare the incidence of rifampin resistance between two groups of patients with a PJI treated with antibiotic regimens involving either immediate or delayed additional rifampin administration and to evaluate the effect of this resistance on the outcome. In this retrospective analysis of routinely collected data, all patients who presented with an acute/chronic PJI between 2018 and 2020 were recorded in the context of a single-center comparative cohort study. Two groups were formed: Group 1 included 25 patients with a PJI presenting in 2018-2019. These patients received additional rifampin only after pathogen detection in the intraoperative specimens. Group 2 included 37 patients presenting in 2019-2020. These patients were treated directly postoperatively with an empiric antibiotic therapy including rifampin. In all, 62 patients (32 females) with a mean age of 68 years and 322 operations were included. We found a rifampin-resistant organism in 16% of cases. Rifampin resistance increased significantly from 12% in Group 1 to 19% in Group 2 (p < 0.05). The treatment failure rate was 16% in Group 1 and 16.2% in Group 2 (p = 0.83). The most commonly isolated rifampin-resistant pathogen was Staphylococcus epidermidis (86%) (p < 0.05). The present study shows a significant association between the immediate start of rifampin after surgical revision in the treatment of PJI and the emergence of rifampin resistance, however with no significant effect on outcome.
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18
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Scheper H, Gerritsen LM, Pijls BG, Van Asten SA, Visser LG, De Boer MGJ. Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2021; 8:ofab298. [PMID: 34258321 PMCID: PMC8271145 DOI: 10.1093/ofid/ofab298] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
The treatment of staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics, and retention of the implant (DAIR) often results in failure. An important evidence gap concerns the treatment with rifampicin for PJI. A systematic review and meta-analysis were conducted to assess the outcome of staphylococcal hip and/or knee PJI after DAIR, focused on the role of rifampicin. Studies published until September 2, 2020 were included. Success rates were stratified for type of joint and type of micro-organism. Sixty-four studies were included. The pooled risk ratio for rifampicin effectiveness was 1.10 (95% confidence interval, 1.00-1.22). The pooled success rate was 69% for Staphylococcus aureus hip PJI, 54% for S aureus knee PJI, 83% for coagulase-negative staphylococci (CNS) hip PJI, and 73% for CNS knee PJI. Success rates for MRSA PJI (58%) were similar to MSSA PJI (60%). The meta-analysis indicates that rifampicin may only prevent a small fraction of all treatment failures.
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Affiliation(s)
- H Scheper
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - L M Gerritsen
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - B G Pijls
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - S A Van Asten
- Department of Microbiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
| | - M G J De Boer
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
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19
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Beldman M, Löwik C, Soriano A, Albiach L, Zijlstra WP, Knobben BAS, Jutte P, Sousa R, Carvalho A, Goswami K, Parvizi J, Belden KA, Wouthuyzen-Bakker M. If, when, and how to use rifampin in acute staphylococcal periprosthetic joint infections, a multicentre observational study. Clin Infect Dis 2021; 73:1634-1641. [PMID: 33970214 PMCID: PMC8563307 DOI: 10.1093/cid/ciab426] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Rifampin is generally advised in the treatment of acute staphylococcal periprosthetic joint infections (PJI). However, if, when, and how to use rifampin remains a matter of debate. We evaluated the outcome of patients treated with and without rifampin, and analyzed the influence of timing, dose and co-antibiotic. Methods Acute staphylococcal PJIs treated with surgical debridement between 1999 and 2017, and a minimal follow-up of 1 year were evaluated. Treatment failure was defined as the need for any further surgical procedure related to infection, PJI-related death or the need for suppressive antimicrobial treatment. Results A total of 669 patients were analyzed. Treatment failure was 32.2% (131/407) in patients treated with rifampin and 54.2% (142/262) in whom rifampin was withheld (P < .001). The most prominent effect of rifampin was observed in knees (treatment failure 28.6% versus 63.9%, respectively, P < .001). The use of rifampin was an independent predictor of treatment success in the multi-variate analysis (OR 0.30, 95% CI 0.20 – 0.45). In the rifampin group, the use of a co-antibiotic other than a fluoroquinolone or clindamycin (OR 10.1, 95% CI 5.65 – 18.2) and the start of rifampin within 5 days after surgical debridement (OR 1.96, 95% CI 1.08 – 3.65) were predictors of treatment failure. The dosing of rifampin had no effect on outcome. Conclusions Our data supports the use of rifampin in acute staphylococcal PJIs treated with surgical debridement, particularly in knees. Immediate start of rifampin after surgical debridement should probably be discouraged, but requires further investigation.
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Affiliation(s)
- Mark Beldman
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Claudia Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laila Albiach
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Paul Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ricardo Sousa
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - André Carvalho
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - Karan Goswami
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Katherine A Belden
- Department of Infectious Diseases, Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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20
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Rifampin, Rifapentine, and Rifabutin Are Active against Intracellular Periprosthetic Joint Infection-Associated Staphylococcus epidermidis. Antimicrob Agents Chemother 2021; 65:AAC.01275-20. [PMID: 33199387 DOI: 10.1128/aac.01275-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/10/2020] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus epidermidis is a major cause of periprosthetic joint infection (PJI); its intracellular persistence within osteoblasts may compromise therapy if that therapy is not intracellularly active. The intracellular activity of rifampin, rifapentine, and rifabutin was assessed against five rifampin-susceptible and two rifampin-resistant S. epidermidis isolates. Compared to no treatment, treatment resulted in a ≥2-fold log10 reduction of intracellular rifampin-susceptible, but not rifampin-resistant, S. epidermidis These findings show activity of rifampin, rifapentine, and rifabutin against intraosteoblast PJI-associated S. epidermidis.
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21
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Abstract
Bone is a dynamic tissue with a quarter of the trabecular and a fifth of the cortical bone being replaced continuously each year in a complex process that continues throughout an individual's lifetime. Bone has an important role in homeostasis of minerals with non-stoichiometric hydroxyapatite bone mineral forming the inorganic phase of bone. Due to its crystal structure and chemistry, hydroxyapatite (HA) and related apatites have a remarkable ability to bind molecules. This review article describes the accretion of trace elements in bone mineral giving a historical perspective. Implanted HA particles of synthetic origin have proved to be an efficient recruiting moiety for systemically circulating drugs which can locally biomodulate the material and lead to a therapeutic effect. Bone mineral and apatite however also act as a waste dump for trace elements and drugs, which significantly affects the environment and human health. Cite this article: Bone Joint Res 2020;9(10):709-718.
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Affiliation(s)
| | | | | | - K Elizabeth Tanner
- School of Engineering and Materials Science and Institute of Bioengineering, Queen Mary University of London, London, UK
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22
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Becker A, Kreitmann L, Ferry T. Reply to Scheper and de Boer's comment on "Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France" by Becker et al. (2020). J Bone Jt Infect 2020; 6:19-20. [PMID: 32983844 PMCID: PMC7517665 DOI: 10.5194/jbji-6-19-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Agathe Becker
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon, France.,Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon, Lyon, France
| | - Louis Kreitmann
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon, France.,Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Tristan Ferry
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon, France.,Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon, Lyon, France.,Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France.,Inserm U1111, Centre international de recherche en Infectiologie (CIRI), Université Claude-Bernard Lyon 1, Lyon, France
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23
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Scheper H, de Boer MGJ. Comment on "Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France" by Becker et al. (2020). J Bone Jt Infect 2020; 6:17-18. [PMID: 32983843 PMCID: PMC7517664 DOI: 10.5194/jbji-6-17-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/01/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Henk Scheper
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333ZA, the Netherlands
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24
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CORR Insights®: Lower Success Rate of Débridement and Implant Retention in Late Acute versus Early Acute Periprosthetic Joint Infection Caused by Staphylococcus spp. Results from a Matched Cohort Study. Clin Orthop Relat Res 2020; 478:1356-1358. [PMID: 32332244 PMCID: PMC7319365 DOI: 10.1097/corr.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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