Int J Antimicrob Agents. 2023 Oct 22:107015. doi: 10.1016/j.ijantimicag.2023.107015. Online ahead of print.
ABSTRACT
AIM OF STUDY: Adjunctive rifampicin for implant associated infections (IAI) is controversial. We investigated the clinical outcomes of rifampicin combination therapy in comparison to monotherapy in treating prosthetic joint infection (PJI) or prosthetic valve endocarditis (PVE) due to staphylococci and streptococci.
METHODS: A systematic search was performed from inception to June 13th 2022 in Embase, Medline, Cochrane, and Web of Science to investigate the clinical outcomes of rifampicin combination therapy in comparison to monotherapy in treating staphylococcal and streptococcal prosthetic joint infection (PJI) or prosthetic valve endocarditis (PVE). Included were randomized clinical trials (RCTs) and observational studies.
RESULTS: Fourteen studies were included. Moderate quality of evidence was found in favor of rifampicin in patients with staphylococcal PJI who underwent debridement, antibiotic and implant retention (DAIR) procedure (Odds Ratio 2.49 (95%CI 1.93 to 3.23). Including the two RCT's only, adding rifampicin to the antibiotic regimen after DAIR was also in favor of rifampicin but not statistically significant (Risk Ratio 1.27 (0.79 to 2.04), n=126). Pooling data of patients with staphylococcal PJI that underwent a 2-stage procedure showed that adding rifampicin was not associated with therapeutic success. Limited evidence was found for use of rifampicin for PVE caused by staphylococci.
CONCLUSIONS: Adding rifampicin in staphylococcal PJI treated by DAIR was clearly increase the chance for therapeutic success. The clinical benefit of adjunctive rifampicin to in treatment of other staphylococci and streptococci IAI is still unclear.
PMID:37875179 | DOI:10.1016/j.ijantimicag.2023.107015