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
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
• 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
•visible purulence of a preoperative aspirate or of
the periprosthetic tissue as determined by the
or Median age (range), years 67 (39-88)
•presence of a sinus tract communicating with the Male gender 30 (64%)
Underlying joint disorder
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.
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).