1141. Treatment of prosthetic joint infection: DAIR with short duration of rifampicin.
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Poster IDSA 2016.pdf (382.7 kB)
  • Background: Evidence for prolonged rifampicin therapy for prosthetic joint infections (PJI) is limited and treatment limiting adverse events are significant. The outcome of patients with PJI treated with DAIR (Debridement, Antibiotics and Implant Retention) including short duration of rifampicin was evaluated.

    Methods: All patients with PJI treated with antimicrobial combination therapy including only five days of rifampicin, started immediately after a DAIR procedure, were enrolled in a cohort study (2003-2014). Patient characteristics, duration and type of antibiotic therapy and duration of follow-up were documented. Outcomes and risk factors for treatment failure were assessed.

    Results: Of the 67 included patients, 49% had hip-PJI and 37% knee-PJI. Rheumatoid arthritis (RA) or a primary bone tumour was present in 24% and 25% of patients. Most prevalent micro-organisms were Staphylococcus aureus (51%), CNS (22%) and streptococci (22%); 24% had a polymicrobial infection. Overall cure rate was 58%. Of failures, 11% had chronic suppressive therapy with retention of the prosthesis and 31% needed prosthesis removal. Patients with acute staphylococcal hip PJI had a cure rate of 86% (table 1). Chronic PJI (RR 1.90, 95%CI 1.12-3.23) and immunosuppressive therapy (RR 1.76, 95%CI 1.03-3.00) were associated with failure. In patients with a relapse, no selection of rifampicin-resistant staphylococci was found.

    Conclusion: In a selected patient population, the outcome of acute PJI treated with DAIR including only 5 days of rifampicin was comparable to the outcome of other published cohort studies and a randomized trial using prolonged rifampicin combination therapy. Immediate postoperative start of rifampicin was not associated with development of rifampicin resistance in staphylococcal PJI. The overall cure rate reflects our frail patient population. A randomized trial comparing long term rifampicin with short term rifampicin therapy is needed.

    Table 1. Subgroup analyses of outcome of DAIR with short duration of rifampicin

    n

    Cure

    All patients

    67

    58%

    Acute PJI (< 21 days)

    57

    63%

    Chronic PJI (≥ 21 days)

    10

    30%

    Patients with immunosuppressants

    18

    39%

    Patients with tumour prosthesis

    17

    47%

    Acute staphylococcal hip or knee PJI

    26

    69%

    Hip PJI

    33

    70%

    Staphylococcal hip PJI

    16

    81%

    Acute staphylococcal hip PJI

    14

    86%

    Henk Scheper, MD1, Daphne Van Hooven, Medical student2, Michiel Van De Sande, MD, PhD3, Stefan De Boer, MD4, Rachid Mahdad, MD5, Martha Van Der Beek, MD, PhD6, Leo Visser, MD PhD1, Mark De Boer, MD PhD1 and Rob Nelissen, MD PhD3, (1)Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands, (2)Leiden University Medical Center, Leiden, Netherlands, (3)Orthopedic Surgery, Leiden University Medical Center, Leiden, Netherlands, (4)Viecuri Medical Center, Venlo, Netherlands, (5)Alrijne Hospital, Leiderdorp, Netherlands, (6)Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands

    Disclosures:

    H. Scheper, None

    D. Van Hooven, None

    M. Van De Sande, None

    S. De Boer, None

    R. Mahdad, None

    M. Van Der Beek, None

    L. Visser, None

    M. De Boer, None

    R. Nelissen, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.