Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients

Abstract

Background. Rifampicin is a pillar in the treatment of periprosthetic joint infection (PJI). However, rifampicin resistance is an increasing threat to PJI treatment. This study explores the incidence of rifampicin-resistant bacteria over time in a Swedish tertiary referral centre and the association of rifampicin resistance with infection-free survival after PJI. Methods. The study included 238 staphylococcal PJIs treated between 2001 and 2020 for which susceptibility data for rifampicin were available. Data on causative bacteria, rifampicin resistance, treatment, and outcome were obtained. Kaplan–Meier survival analysis and Cox regression modelling estimated the infection-free cumulative survival and adjusted hazard ratios (HRs) for the risk of treatment failure. Results. Rifampicin-resistant causative bacteria were identified in 40 cases (17%). The proportion of rifampicin-resistant agents decreased from 24% in 2010–2015 to 12% in 2016–2020. The 2-year infection-free survival rates were 78.6% (95% CI, 66.4–93.1%) for the rifampicin-resistant group and 90.0% (95% CI, 85.8–94.4%) for the rifampicin-sensitive group. Patients with PJI caused by rifampicin-resistant bacteria had an increased risk of treatment failure (adjusted HR, 4.2; 95% CI, 1.7–10.3). Conclusions. The incidence of PJI caused by rifampicin-resistant bacteria did not increase over the past 20 years. The risk of treatment failure in PJI caused by rifampicin-resistant bacteria is more than four times that caused by rifampicin-sensitive bacteria, highlighting the importance of limiting the development of rifampicin resistance.

Early Staphylococcal Periprosthetic Joint Infection (PJI) Treated with Debridement, Antibiotics, and Implant Retention (DAIR): Inferior Outcomes in Patients with Staphylococci Resistant to Rifampicin

“…Recent research has provided insights into the role of rifampicin in PJI treatment. In cases involving patients with rifampicin-sensitive bacteria, those who received rifampicin had a lower risk of infection relapse, with 2-year infectionfree survival rates of 92% compared to 83% [67]. These findings are in line with the conclusions presented by Karlsen and colleagues [68] for a randomized controlled trial comprising 48 patients who underwent DAIR for acute staphylococcal PJI.…”

“…A study outlining the occurrence of rifampicin-resistant bacteria isolated from PJI patients reported a consistent 24% level of rifampicin resistance in PJI-associated bacteria over a 6-year period [71]. In contrast, a more recent study spanning two decades at our unit unveiled a declining trend in PJIs caused by rifampicin-resistant bacteria when comparing the time frames of 2011-2015 and 2016-2020 [67].…”

“…This was further highlighted in a study where researchers investigated the relationship between the rifampicin resistance of the bacteria responsible for PJI and the overall treatment outcomes. The authors found that the risk of infection relapse was 4.2 times higher for patients with an infection caused by rifampicin-resistant bacteria compared to those who suffered from PJIs caused by rifampicin-sensitive strains [67].…”

Rifampin-resistant periprosthetic joint infections are associated with worse functional outcome in both acute and chronic infection types

“…Additional research suggests that the timing of rifampin administration plays a pivotal role, with delayed introduction signi cantly reducing the emergence of rifampin resistance [12,14]. Belman et al, in their multicentre observational study, demonstrated that the timing of administration had a signi cant in uence on the treatment failure rate.…”

“…Rifampin resistance causes a signi cantly higher number of surgical revisions and is associated with lower recovery rates [11,12]. Additionally, the risk of treatment failure in PJI caused by rifampin-resistant bacteria surpasses that associated with rifampin-sensitive bacteria [13,14].…”