ROLE OF RIFAMPIN COMBINATION THERAPY IN THE TREATMENT OF STAPHYLOCOCCUS-INFECTED ARTHROPLASTY

Abstract

Introduction: The purpose of this study is the evaluation of the role of combination chemotherapy with rifampin in the treatment of Staphylococcus-infected arthroplasties, without removal of the implants. The study started on July 1997 and is still open today. The enrolled patients refused surgical operation or were not eligible for it.

Material and Methods: we examined patients with hip or knee infected arthroplasties. The hip prostheses infections were treated with an oral therapy for 6 months, while the knee prostheses infections were treated for 9 months. Follow up was extended to two years. Cure should be defined as the absence of clinical, radiological and biological evidence of infection after two years, but we also considered the clinical success at one year as the study is still open, so that not all the patients finished the two-years follow-up, and more, no relapses had been observed after one year of follow-up.

Results: 42 patients with an arthroplatsy infection (16 knee prostheses and 26 hip prostheses due to Staphilococcus spp (23 S aureus and 19 SCN) were enrolled in our study; the middle age was 69.4. 27 of 42 patients treated with rifampin were examined at one year follow up; no relapses had been observed after one year of follow-up. Rifampin was used in combination with: ciprofloxacin (n° 16), TMP/SMX (n° 10) or fusidic acid (n° l).

The success rate after 1 year was of 81.5% (22 of 27 patients): 90% success rate for methicillin-resistant Staphilococci (9/10) and 76.5% for methicillin-susceptible Staphilococci (13/17). The patients with infection due to S. aureus had a success rate of 83.3% (10/12). whereas for infections due to SCN was 80% (12/15). The success rate for hip prostheses infection was of 83.3% (15/18) and 77.8% (7/9) for knee prostheses infection. The overall success rate after two years of follow up today is 77% (17/22), two patients dead because of cancer.

Conclusions: the long-term treatment with rifampin combination appears to be a satisfactory choice for patients that can’t be eligible for surgical revision or that refuse it.