683. Tolerance of rifampin-fluoroquinolone combinations (RFC) in the treatment of prosthetic joint infections (PJIs) about a series of 201 patients
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: clinical studies recently published have established RFC use as a factor associated with favorable outcome of patients treated for staphylococcal PJIs. Nevertheless, data on tolerance of RFC according to daily dosing are lacking. 

Methods: medical charts of patients treated with RFC in a single French referral center for PJI were reviewed with focus on the daily dosing of both components of the combination and the occurrence of suspected antibiotic-related adverse events.  

Results: a total of 201 patients (99M/102F, of mean age 64.8±13.8 years) treated between 2001 and 2009 were included for analysis. A cause of immunosuppression was identified in 54 (26.9%) patients including diabetes in 45 of them. There were 110 (54.7%) total hip prostheses, 87 (43.3%) total knee prostheses and 4 (2%) total shoulder prostheses. Intra-operative samples and/or pre-operative joint aspirations identified Gram-positive cocci in 179 cases, including coagulase negative staphylococci (n=87) and S. aureus (n=60), Gram-negative bacilli in 10 and strict anaerobes in 19 cases. Median rifampin-daily dose was 1,200mg (range 300-2100mg) divided into 2 doses in 173 (86.1%) patients and mean daily dose/body weight in kg was 16.1±4.3. Total RFC treatment duration was 89.1 ±68.4 days including a intravenous administration period of 5.9±12.8 days. RFC treatment had to be stopped in 33 patients (16.4%) for digestive intolerance (n=17), myalgia/tendonitis (n=7), allergy (n=7) or acute renal insufficiency (n=2). The mean delay from initiation and withdraw of RFC treatment was 27.4±33.7 days. Reduction of RFC daily dosing was required in 33 (16.4%) additional patients because of digestive adverse events. The proportion of patients who had to stop RFC treatment or required a reduction of the daily dose was 35.3% for daily dosing of rifampin (DDR)≤600mg, 45.3% for >600mg DDR ≤1200mg and 63.8%  for DDR >1200mg (P=0.04). DD of either fluoroquinolone or rifampin had no impact on the patients' clinical outcome.

Conclusion: our results suggest that overall tolerance of patients treated for PJIs to RFC treatment is acceptable. The occurrence of adverse events related to RFC depends on the daily dosing of rifampin whereas patients’ clinical outcome does not.  


Subject Category: J. Clinical practice issues

Eric Senneville, MD1, Laurence Legout, MD1, Henri Migaud, PH MD2, Yazdan Yazdanpanah, MD, PhD1 and Eric Beltrand, MD1, (1)Dron Hospital, Tourcoing, France, (2)Roger Salengro Hospital, Lille, France

Disclosures:

E. Senneville, None

L. Legout, None

H. Migaud, None

Y. Yazdanpanah, None

E. Beltrand, None

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