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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
                                    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
                                                                        staphyloccal PJI.
      •visible purulence of a preoperative aspirate or of
       the periprosthetic tissue as determined by the
                                                                           Characteristics                                                    Value
      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).

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