1Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
1Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Diagn Microbiol Infect Dis. 2024 Oct;110(2):116447. doi: 10.1016/j.diagmicrobio.2024.116447. Epub 2024 Jul 19.
Periprosthetic joint infections (PJI) pose a significant challenge in orthopaedic surgery, often requiring extensive surgical debridement and prolonged antibiotic treatment to eliminate the causative pathogens. Rifampin, known for its potent activity against biofilms, has been crucial in managing PJI by penetrating and disrupting these formations, thereby improving treatment efficacy. In this sense, antibiotic protocols lacking rifampin have shown increased failure rates. Consequently, the development of rifampin resistance could severely influence the prognosis of PJI. The aim of this clinical study was to assess how rifampin resistance affects the functional outcome in patients with PJI. In this single-centre comparative cohort study, we systematically documented all patients who presented with a PJI during the period spanning from 2018 to 2020. Two distinct groups were established for the study: Group 1 comprised 35 patients with a PJI caused by rifampin-susceptible pathogens and group 2 consisted of 28 patients with PJI caused by rifampin-resistant pathogens. A total of 63 patients (34 females) with a mean age of 68 years and a mean follow up of 37 months were included. The examination of patient-specific parameters did not reveal any identified risk factors as influential. Patients with a rifampin-resistant pathogen underwent a greater number of surgical revisions (6.9 ± 5.1 compared to 3.59 ± 3.39, p = 0.0011) and had extended durations of antibiotic treatment (p = 0.0052). The results of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score revealed significant differences in clinical outcome between both groups in every domain, even when stratified by acute and chronic entities. In total the WOMAC increased significantly from 21.57 ± 14.9 points in group 1 to 71.47 ± 62.7 points in group 2 (p < 0.001). The higher failure rates observed in group 2 were not statistically significant (p = 0.44). The current study demonstrates that PJI caused by rifampin-resistant bacteria are associated with a significantly worse functional outcome in both acute and chronic infection types without significantly affecting total failure rates.
人工关节周围感染（PJI）是骨科手术面临的重大挑战，通常需要广泛的外科清创和长期的抗生素治疗来消除致病病原体。利福平以其对抗生物膜的强大活性而闻名，通过穿透和破坏这些生物膜，对 PJI 的治疗效果至关重要。从这个意义上说，缺乏利福平的抗生素方案显示出更高的失败率。因此，利福平耐药的发展可能严重影响 PJI 的预后。本临床研究旨在评估利福平耐药如何影响 PJI 患者的功能结局。在这项单中心比较队列研究中，我们系统地记录了 2018 年至 2020 年期间出现 PJI 的所有患者。为研究建立了两个不同的组：组 1 包括 35 例由利福平敏感病原体引起的 PJI 患者，组 2 包括 28 例由利福平耐药病原体引起的 PJI 患者。共有 63 名患者（34 名女性）纳入研究，平均年龄 68 岁，平均随访 37 个月。对患者特定参数的检查未发现任何有影响的确定危险因素。利福平耐药病原体患者经历了更多的手术翻修（6.9±5.1 次比 3.59±3.39 次，p=0.0011），抗生素治疗时间延长（p=0.0052）。西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分的结果显示，两组在每个领域的临床结局均存在显著差异，即使在急性和慢性实体亚组中也是如此。WOMAC 评分在组 1 从 21.57±14.9 分显著增加至组 2 的 71.47±62.7 分（p<0.001）。组 2 中观察到的更高失败率没有统计学意义（p=0.44）。本研究表明，利福平耐药菌引起的 PJI 在急性和慢性感染类型中均与功能结局显著恶化相关，而不会显著影响总失败率。
