Dramatic reduction of clindamycin serum concentration in staphylococcal osteoarticular infection patients treated with the oral clindamycin-rifampicin combination

Bernard, Aurélie; Kermarrec, Gwénolé; Parize, Perrine; Caruba, Thibaut; Bouvet, Anaïs; Mainardi, Jean–Luc; Sabatier, Brigitte; Nich, Christophe

doi:10.1016/j.jinf.2015.03.013

Cited by 31 publications

(24 citation statements)

References 26 publications

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“…Despite MIC values for rifampin and levofloxacin in Cutibacterium are generally in the susceptible range, emergence of resistance to both antibiotics has been reported [ 31 , 49 ] and antimicrobial susceptibility testing is essential. As a dramatic decrease of clindamycin serum concentrations was shown in patients with staphylococcal osteoarticular infections treated with oral clindamycin-rifampicin combination, it is considered a second line combination partner for antibiotic regimens with rifampicin aiming at infection eradication, unless clindamycin serum concentration is thoroughly controlled [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

et al. 2018

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BackgroundThe definition criteria and clinical characteristics of implant-associated infection (IAI) caused by Cutibacterium (formerly Propionibacterium) spp. are poorly known. We analyzed microbiologically proven Cutibacterium orthopedic IAI in a prospective cohort.MethodsPatients with periprosthetic joint infections (PJI) and fixation device–associated infections (FDAI) caused by Cutibacterium spp. were prospectively included. IAI was defined by significant growth of Cutibacterium spp. and presence of at least one non-microbiological criterion for infection. The McNemar’s chi-squared or binomial test was used to compare the performance of diagnostic tests.ResultsOf 121 patients with Cutibacterium IAI, 62 patients (51%) had PJI and 59 (49%) had FDAI. 109 infections (90%) were caused by C. acnes and 12 (10%) by C. avidum. The median time from implantation until diagnosis of infection was 15.7 months (interquartile range, 5–46.5 months). Clinical local signs were present in 30 patients (28%) and radiological implant loosening in 64 patients (63%). Culture sensitivity of sonication fluid was 84%, of peri-implant tissue 84% and of synovial or peri-implant fluid 56% after 14 days of incubation.ConclusionCutibacterium IAI was diagnosed late in the disease course and presented with subtle signs. Prolonged culture incubation and implant sonication improved the poor performance of conventional microbiological tests. Due to lack of reliable diagnostic tests, Cutibacterium remains difficult to detect making the diagnosis challenging.

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Section: Discussionmentioning

confidence: 99%

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

et al. 2018

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“…While performing this study, two articles on the pharmacokinetics of the clindamycin-rifampin combination regimen were published [34, 35]. Bernard et al and Cruris et al reported a dramatic reduction of clindamycin serum concentration in patients receiving clindamycin with rifampin compared to patients receiving clindamycin without rifampin.…”

Section: Discussionmentioning

confidence: 99%

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study

et al. 2017

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BackgroundStaphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.MethodsIn this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months.Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.ResultsIn this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.ConclusionCombined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

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“…It inhibits production of S. aureus toxins (Otto et al 2013), additionally to the exhibition of its antibacterial activity. Combination of clindamycin with rifampin has also been suggested (Czekaj et al 2011), but recent pharmacokinetic studies demonstrated dramatic reduction of clindamycin serum concentration if combined with rifampin (Bernard et al 2015a;Join-Lambert et al 2014). Therefore, caution is recommended regarding this combination until more data become available.…”

Section: Antimicrobial Treatmentmentioning

confidence: 99%

Staphylococcus aureus-Associated Musculoskeletal Infections

Idelevich

Kreis

Löffler

et al. 2016

Current Topics in Microbiology and Immunology

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Musculoskeletal infections caused by Staphylococcus aureus are among the most difficult-to-treat infections. S. aureus osteomyelitis is associated with a tremendous disease burden through potential for long-term relapses and functional deficits. Although considerable advances have been achieved in diagnosis and treatment of osteomyelitis, the management remains challenging and impact on quality of life is still enormous. S. aureus acute arthritis is relatively seldom in general population, but the incidence is considerably higher in patients with predisposing conditions, particularly those with rheumatoid arthritis. Rapidly destructive course with high mortality and disability rates makes urgent diagnosis and treatment of acute arthritis essential. S. aureus pyomyositis is a common disease in tropical countries, but it is very seldom in temperate regions. Nevertheless, the cases have been increasingly reported also in non-tropical countries, and the physicians should be able to timely recognize this uncommon condition and initiate appropriate treatment. The optimal management of S. aureus-associated musculoskeletal infections requires a strong interdisciplinary collaboration between all involved specialists.

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Dramatic reduction of clindamycin serum concentration in staphylococcal osteoarticular infection patients treated with the oral clindamycin-rifampicin combination

Cited by 31 publications

References 26 publications

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study

Staphylococcus aureus-Associated Musculoskeletal Infections

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