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					                                    Outcome of periprosthetic joint infection caused by rifampin-resistant                                                                                                                                  Katja Eigenmann
                                                                                                                                                                                                                                            Division of Infectious Diseases and

   P 1655                                                      staphylococci                                                                                                                                                                Hospital Epidemiology
                                                                                                                                                                                                                                            University Hospital Zurich
                                                                                                                                                                                                                                            Rämistrasse 100, CH-8091 Zürich
                                                                              1KatjaEigenmann, 1Yvonne Achermann, 2Martin Clauss, 3Philippe Rafeiner, 2Linda Derksen, 4Reto Nüesch,                                                         Phone: +41 44 255 20 54
                                                                                               5Claudine Zellweger, 6,7Markus Vogt, 2Werner Zimmerli, 8Andrej Trampuz
                                                                                                                                                                                                                                            Email: katja.eigenmann@usz.ch
                                    1University Hospital Zurich, Zurich, 2Basel University Medical Clinic, Liestal, 3Cantonal Hospital St. Gallen, St. Gallen, 4Clinic Hirslanden St. Anna, Lucerne, 5Clinic Hirslanden Beau-Site, Bern
                                                                    6Cantonal Hospital Zug, Baar, 7Orthopedic Clinic Schulthess, Zurich, 8University and University Hospital Lausanne, Lausanne




                   Objectives                                                                                 Results                                                                                                   Results
                                                                                                                                                                              Table 2. Surgical treatment and the respective outcome.
 • Periprosthetic joint infections (PJI) caused by rifampin-           •Demographic and clinical data. We included 47 patients with rifampin resistant
   resistant staphylococci are considered difficult to treat.          staphylococcal PJI (S.aureus, n=9; CNS, n=38). Figure 1 shows the distribution of
                                                                       the type of device in all patients of the study. Demographic and clinical
 • The optimal treatment approach of such infections is                                                                                                                                                                                                   N° of patients
                                                                       characteristics of all 47 patients at time of diagnosis of a rifampin resistant                           Surgical treatment                      Nr. of patients (%)
   not standardized. We recommend a 2-stage exchange                                                                                                                                                                                                      w/o relapse
                                                                       staphyloccal PJI are summarized in table 1.
   of the device with a long interval (>8 weeks) without
                                                                                                                                                                                Debridement and implant
   use of a spacer [NEJM 351:1645-54,2004].                            •Treatment. Antibiotic treatment was given intravenously for a median of 27 days                                                                          13 (27.5)                     6 (46.2%)
                                                                       (range 0-102) with a median total treatment time of 3 months (range 0.5-101
                                                                                                                                                                                retention
 • In this study, we investigated whether PJI caused by
                                                                       months). Surgical treatment and the respective outcome were summarized in                                1-stage exchange                                   9 (19)                      7 (77.8%)
   rifamipin-resistant staphylococci are indeed difficult to
                                                                       table 2 and figure 2.                                                                                    2-stage exchange with short
   treat, and therefore 2-stage-exchange is justified.
                                                                                                                                                                                                                                  4 (8.5)                       2 (50%)
                                                                                                                                                                                interval (<6 weeks)
                                                                        Figure 1. Type of prosthesis and infecting agent in 47 included patients
                                                                                                                                                                                2-stage exchange with long
                                                                                                                                                                                                                                  16 (34)                      12 (75%)
                       Methods                                                                                                                                                  interval (≥ 8 weeks)
                                                                                                                                                                                Resection arthroplasty                            4 (8.5)                      4 (100%)
• Inclusion criteria: In a multicenter Study (01/2000-
  12/2010),    PJI    caused     by    rifampin-resistant
                                                                                                                                                                                 No surgical intervention                         1 (4.7)                        0 (0%)
  Staphylococcus     aureus    or   coagulase-negative
  staphylococci (CNS) were retrospectively included.
• Exclusion criteria: Incomplete medical records.                                                                                                                              Figure 2. Kaplan-Meier curves show the relapse-free survival after 1, 2 and 3 years
                                                                                                                                                                               overall, after 2-stage exchange (long interval) and after debridement/rentention.
• Definition of PJI:                                                    Table 1. Characteristics of 47 patients at time of rifampin resistant
                                                                        staphyloccal PJI.
      •visible purulence of a preoperative aspirate or of
       the periprosthetic tissue as determined by the
                                                                           Characteristics                                                    Value
       surgeon,
      or                                                                   Median age (range), years                                        67 (39-88)

      •presence of a sinus tract communicating with the                    Male gender                                                       30 (64%)
       device,
                                                                          Underlying joint disorder
      or
                                                                                 Primary degenerative osteoarthritis                        34 (72.3%)
      •microbial growth in a preoperative joint aspirate,                                                                                                                                       75%
                                                                                 Rheumatic osteoarthritis                                    4 (8.5%)                                                            60%
       intraoperative periprosthetic tissue or sonication                                                                                                                                                                           55%
       fluid of the removed implant or synovial fluid with                       Posttraumatic arthritis                                    9 (19.2%)
       >1700 leukocytes/µl or >65% granulocytes.
                                                                          Medical history: number of previosu revisions
• Follow-up: Patients were regularly followed at the
  outpatient orthopedic clinic or were contacted by                              <3                                                          15 (32%)                                                             Conclusions
  phone.                                                                         ≥3                                                          32 (68%)
                                                                                                                                                                               PJI caused by rifampin-resistant staphylococci are indeed difficult to treat and
• Outcome: A relapse was defined as recurrence of PJI                                                                                                                          should be managed by 2-stage-exchange of the device with a long interval (at
                                                                          Previous PJI, treated with antibiotics (any)                       34 (72%)
  with the same microorganism. Kaplan-Meier survival                                                                                                                           least 8 weeks). The role of the presence or absence of a spacer cannot be
  curve and Cox proportional regression analysis were                     Previous rifampin treatment                                        41 (85%)                          determined.
  performed.
                                                                          Inadequate previous rifampin treatment                            18 (37.5%)                         Acknowledgments: This work was supported by a grant of the Hans-Paul Wälchli Foundation for
                                                                                                                                                                               Research (Lugano, Switzerland).

				
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posted:9/17/2012
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