Adjunctive Rifampin Following Debridement and Implant Retention for Staphylococcal Prosthetic Joint Infection: Is it Effective if not Combined With a Fluoroquinolone?

Cortés-Penfield, Nicolás W; Hewlett, Angela; Kalil, André C.

doi:10.1093/ofid/ofac582

Cited by 4 publications

(7 citation statements)

References 15 publications

(19 reference statements)

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“…Rifampin has been recommended as one of the therapeutic agents for the treatment of staphylococcal infections due to its potent bactericidal activity against S. aureus [ 4 , 5 , 13 , 14 ]. It has been shown to be highly effective in treating staphylococcal infections related to foreign bodies [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Fluoroquinolones have been considered the best antibiotics to use in combination with rifampin for the treatment of S. aureus infections [ 4 , 5 , 19 , 20 , 21 ]. However, studies have not shown consistent synergistic effects with the combination of fluoroquinolones and rifampin, and in some studies, antagonism has been reported [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Combination therapy has emerged as a potential solution to tackle device-related infections caused by drug-resistant S. aureus , and many studies have examined the efficacy of combining different antibiotics. In particular, a combination of rifampin plus fluoroquinolone has been recommended for the treatment of staphylococcal prosthetic joint infection [ 4 , 5 ]. However, the benefit of this combination remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Comparing the Synergistic and Antagonistic Interactions of Ciprofloxacin and Levofloxacin Combined with Rifampin against Drug-Resistant Staphylococcus aureus: A Time–Kill Assay

Kang

Chung

et al. 2023

Antibiotics

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Background: Treatment of device-related infections by drug-resistant Staphylococcus aureus can be challenging, and combination therapy has been proposed as a potential solution. We compared the effectiveness of levofloxacin–rifampin and ciprofloxacin–rifampin combinations in killing methicillin-resistant S. aureus (MRSA) using a time–kill assay. Methods: We randomly selected 15 vancomycin-susceptible S. aureus (VSSA) strains, 3 vancomycin-intermediate S. aureus (VISA) strains, and 12 heterogeneous VISA (hVISA) strains from the Asian Bacterial Bank. Time–kill experiments were performed in duplicate for each isolate. Viable bacterial counts were determined at 0 h, 4 h, 8 h, and 24 h for the ciprofloxacin– and levofloxacin–rifampin combinations at 1× MIC and 0.5× MIC. We compared synergistic and antagonistic interactions between the two combinations. Results: The viable bacterial count significantly decreased after 24 h of exposure to ciprofloxacin–rifampin and levofloxacin–rifampin combinations, with synergy observed more frequently in isolates exposed to ciprofloxacin–rifampin (43.3%) than levofloxacin–rifampin (20.0%) (p = 0.0082). The synergistic interactions of both combinations were more frequently observed in resistant strains with high MICs of ciprofloxacin (≥16 mg/L) and levofloxacin (≥8 mg/L). Levofloxacin tended to exhibit more frequent antagonistic interactions with rifampin than ciprofloxacin, although there was no statistical difference in antagonism between the two combinations. Conclusions: Our study demonstrated that ciprofloxacin exhibits superior synergistic activity against MRSA strains, including VISA/hVISA, when combined with rifampin compared with levofloxacin. High MICs of fluoroquinolones were found to predict synergism. Our results suggest that ciprofloxacin may be a more effective choice than levofloxacin for combination therapy with rifampin in the treatment of MRSA infections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing the Synergistic and Antagonistic Interactions of Ciprofloxacin and Levofloxacin Combined with Rifampin against Drug-Resistant Staphylococcus aureus: A Time–Kill Assay

Kang

Chung

et al. 2023

Antibiotics

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“…8 Although the role of rifampin for staphylococcal hardware infections remains unsettled, a recent expert review continued to support its use. 9,10 Case 2: Mycobacterial infection in an immunocompromised and pregnant host A 30-year-old pregnant female at 13-weeks gestation with a history of indeterminate colitis, on infliximab therapy for 2 years, and latent tuberculosis treated with 4 months of rifampin prior to initiation of infliximab, presented with 4 months of a The patient remained on fluconazole with plans to complete 12 months of therapy, and received periodic laboratory and clinical monitoring to ensure an optimal outcome (COpAT). Her persistent pulmonary nodules were thought to represent scarred granulomas and sequelae of prior infection rather than an ongoing active fungal disease.…”

Section: Case 1: Methicillin-susceptible Staphylococcus Aureus Bacter...mentioning

confidence: 99%

“…8 Although the role of rifampin for staphylococcal hardware infections remains unsettled, a recent expert review continued to support its use. 9,10…”

Section: Introductionmentioning

confidence: 99%

What is the role of the clinical microbiology laboratory in the care of diagnostically challenging OPAT patients? Illustrative cases and literature review

Nori,

Thwe,

Mogollon

et al. 2023

Therapeutic Advances in Infection

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Optimal care of patients requiring long-term outpatient parenteral or oral antimicrobial therapy by infectious diseases (ID) specialists is facilitated by an accurate microbiologic diagnosis. Close collaboration between ID specialists and the clinical microbiology laboratory for routine or specialized molecular testing can result in more accurate diagnoses, streamlined antimicrobial regimens, and improved patient outcomes.

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Role of Routine Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infections

Tai,

Tande,

Langworthy

et al. 2024

Open Forum Infectious Diseases

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Background Debridement, antibiotics, irrigation, and implant retention (DAIR) is the first-line management strategy for acute periprosthetic joint infections (PJI). Suppressive antibiotic therapy (SAT) after DAIR is proposed to improve outcomes, yet its efficacy remains under scrutiny. Methods We conducted a multicenter retrospective study in patients with acute PJI of the hip or knee and treated with DAIR in centers from Europe and the USA. We analyzed the effect of SAT using a Cox model landmarked at 12 weeks. The primary covariate of interest was SAT, which was analyzed as a time-varying covariate. Patients who experienced treatment failure or lost to follow-up within 12 weeks were excluded from the analysis. Results The study included 510 patients with 66 treatment failures with a median follow-up of 801 days. We did not find a statistically significant association between SAT and treatment failure (HR 1.37, 95% CI 0.79-2.39, p=0.27). Subgroup analyses for joint, country cohort, and type of infection (early or late acute) did not show benefit for SAT. Secondary analysis of country cohorts showed a trend toward benefit for the USA cohort (HR 0.36, 95% CI 0.11-1.15, p=0.09) which also had the highest risk of treatment failure. Conclusion The utility of routine SAT as a strategy for enhancing DAIR's success in acute PJI remains uncertain. Our results suggest that SAT's benefits might be restricted to specific groups of patients, underscoring the need for randomized controlled trials. Identifying patients most likely to benefit from SAT should be a priority in future studies.

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Adjunctive Rifampin Following Debridement and Implant Retention for Staphylococcal Prosthetic Joint Infection: Is it Effective if not Combined With a Fluoroquinolone?

Cited by 4 publications

References 15 publications

Comparing the Synergistic and Antagonistic Interactions of Ciprofloxacin and Levofloxacin Combined with Rifampin against Drug-Resistant Staphylococcus aureus: A Time–Kill Assay

Comparing the Synergistic and Antagonistic Interactions of Ciprofloxacin and Levofloxacin Combined with Rifampin against Drug-Resistant Staphylococcus aureus: A Time–Kill Assay

What is the role of the clinical microbiology laboratory in the care of diagnostically challenging OPAT patients? Illustrative cases and literature review

Role of Routine Suppressive Antibiotic Therapy After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infections

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