The Impact of Surgical Strategy and Rifampin on Treatment Outcome in Cutibacterium Periprosthetic Joint Infections

Abstract

Background Cutibacterium species are common pathogens in periprosthetic joint infections (PJI). These infections are often treated with β-lactams or clindamycin as monotherapy, or in combination with rifampin. Clinical evidence supporting the value of adding rifampin for treatment of Cutibacterium PJI is lacking. Materials/methods In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection within a minimal follow-up of 12 months. We used Fisher’s exact tests and Cox proportional hazards models to analyze the effect of rifampin and other factors on clinical success after PJI. Results We included 187 patients (72.2% male, median age 67 years) with a median follow-up of 36 months. The surgical intervention was two-stage exchange in 95 (50.8%), one-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%). Rifampin was included in the antibiotic regimen in 81 (43.3%) cases. Infection relapse occurred in 28 (15.0%), and new infection in 13 (7.0%) cases. In the time-to-event analysis, DAIR (adjusted HR=2.15, p=0.03) and antibiotic treatment over 6 weeks (adjusted HR=0.29, p=0.0002) significantly influenced treatment failure. We observed a tentative evidence for a beneficial effect of adding rifampin to the antibiotic treatment – though not statistically significant for treatment failure (adjusted HR=0.5, p=0.07) and not for relapses (adjusted HR=0.5, p=0.10). Conclusions We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI but a dedicated prospective multicenter study is needed.

The role of biofilm formation in the pathogenesis and antimicrobial susceptibility of Cutibacterium acnes

“…In general, the infection free outcome after treatment of periprosthetic joint infections due to Cutibacterium spp. is about 85%, but worse if only a debridement is performed and the implant is retained [ 68 ]. This observation indicates that these infections are biofilm-related and that removal of the periprosthetic biofilm is needed to increase success rate.…”

“…In a large multicenter study studying risk factors for Cutibacterium spp. relapses, radical surgery and a prolonged antibiotic treatment over 6 weeks led to the best outcomes and avoided relapse of infection [ 68 ]. This is yet another indication for the biofilm character of the infection, as a non-biofilm infection would be expected to heal with a shorter antibiotic treatment.…”

Bone infection site targeting nanoparticle-antibiotics delivery vehicle to enhance treatment efficacy of orthopedic implant related infection

“…Unfortunately, there is currently no gold standard for the therapy of orthopedic implant-related infections. Antibiotic therapy continues to play a vital role in the clinical treatment of orthopedic implant-related infections, usually involving systemic or local antibiotic therapy at high doses over a prolonged period [ 4 , 5 ]. However, the current antibiotic therapy is still far from satisfactory, with treatment failure rates of approximately 20% [ 6 ].…”

Genomic Analysis of Cutibacterium acnes Strains Isolated from Prosthetic Joint Infections

“…Among PJI-associated strains, six belonged to cases with a good outcome and six cases had an infection relapse ( Supplementary Table S1 ). All cases, including relapse cases, were previously treated with surgical debridement and antibiotics [ 36 ]. Infection relapse was defined when persisting signs or symptoms of infection (pain, swelling, redness, wound secretion, elevated serum inflammatory parameters) were present after surgical debridement and antibiotic treatment, and two samples from periprosthetic tissue were positive for C. acnes based on conventional culture methods.…”

“…Overall, our results revealed that C. acnes isolates from patients with treatment success and failure were genetically similar, suggesting that treatment failure might be primarily related to the choice of antibiotics and clinical management, rather than dependent on the actual causative strain [ 36 ]. Similar results were seen in a study with S. aureus strains [ 48 ], in which isolates from patients with treatment success and failure were genetically very similar, indicating that treatment failure was associated with the presence of an antimicrobial-resistant phenotype and the use of non-biofilm-active antibiotic treatment.…”