Grünwald Leonard, Blersch Benedikt Paul, Fink Bernd
Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
Department of Trauma and Reconstructive Surgery, BG Klinik, University of Tübingen, Schnarrenbergstraße 95, 72076 Tübingen, Germany.
Antibiotics (Basel). 2025 Jun 16;14(6):610. doi: 10.3390/antibiotics14060610.
: Periprosthetic joint infection (PJI) is a severe complication that follows arthroplasty and occurs in approximately 2% of all cases. One of several cornerstones of therapy is an optimized antibiotic regimen. Early administration of rifampicin-together with a combination of an antibiotic to which the specific microorganism is susceptible-accompanying a two-stage revision surgery, remained controversial due to the potential risk of emerging resistance. However, the exact time to start rifampicin treatment often remains unclear and might be crucial in the treatment regimen. : In a retrospective study design, a total of 212 patients receiving a two-stage revision surgery after a diagnosis of PJI (60.8% THA, 39.2% TKA) received an individual rifampicin combination therapy after initial debridement and removal of all foreign material, starting rifampicin on the second day postoperatively. : At the time of spacer explantation, two patients had developed rifampicin resistance (0.9%). At follow-up (M = 55.4 ± 21.8 months) after reimplantation, three patients had developed rifampicin resistance (1.4%). Concerning the development of reinfection, in general, in the study group and the necessity for further treatment, a total of 25 patients showed signs of reinfection (11.8%). : Only 0.9% after the first stage and 1.4% at follow-up after the second stage of all 212 patients with accompanying long-term rifampicin combination therapy developed a rifampicin resistance. Therefore, rifampicin administration could be started on the second postoperative day when sufficient concentrations of the accompanying antibiotics can be expected.
人工关节周围感染（PJI）是关节置换术后的一种严重并发症，约占所有病例的2%。优化抗生素治疗方案是治疗的几个基石之一。在两阶段翻修手术中，早期给予利福平以及特定微生物敏感的抗生素联合使用，由于存在出现耐药性的潜在风险，一直存在争议。然而，开始利福平治疗的确切时间往往仍不明确，而这在治疗方案中可能至关重要。：在一项回顾性研究设计中，共有212例诊断为PJI后接受两阶段翻修手术的患者（60.8%为全髋关节置换术，39.2%为全膝关节置换术）在初次清创和清除所有异物后接受了个体化利福平联合治疗，术后第二天开始使用利福平。：在取出间隔器时，有2例患者出现了利福平耐药（0.9%）。在再次植入后的随访（平均时间M = 55.4 ± 21.8个月）中，有3例患者出现了利福平耐药（1.4%）。关于再感染的发生情况，总体而言，在研究组以及进一步治疗的必要性方面，共有25例患者出现了再感染迹象（11.8%）。：在所有212例接受长期利福平联合治疗的患者中，第一阶段后只有0.9%，第二阶段随访时为1.4%出现了利福平耐药。因此，当预期联合使用的抗生素能达到足够浓度时，可在术后第二天开始使用利福平。
