Leal Justin, Kugelman David N, Shah Sharrieff, Mackowiak Amy, Wrenn Rebekah, Jiranek William A, Seyler Thorsten M, Ryan Sean P, Seidelman Jessica
Department of Orthopaedic Surgery.
Duke University, Durham, North Carolina; and the Department of Orthopaedic Surgery, Rothman Orthopaedics, Philadelphia, Pennsylvania.
Orthopedics. 2025 Jul-Aug;48(4):239-247. doi: 10.3928/01477447-20250618-01. Epub 2025 Jul 3.
This study evaluated outcomes of patients meeting Infectious Disease Society of America guidelines for rifampin therapy in treating staphylococcal periprosthetic joint infection (PJI) and explored the role of rifabutin as a substitute when rifampin was contraindicated due to drug-drug interaction (DDI).
An institutional database at a tertiary referral center was queried for patients who had staphylococcal PJI and underwent debridement and implant retention procedure (DAIR) or one-stage revision from January 1, 2013, to April 30, 2023. Patients were stratified by rifampin treatment, and their rates of successful PJI treatment were compared. Rifampin and rifabutin DDIs were collected for all patients and compared.
Of 935 total patients screened, 87 patients with a mean follow-up time of 4.4 years met IDSA guidelines for rifampin therapy. Of the 35 patients who completed rifampin therapy, 71.4% were successfully treated. Logistic regression analysis showed that those who did not initiate rifampin therapy were less likely to have successful treatment (odds ratio: 0.76 [0.60 to 0.97]; =0.031). Cox-proportional hazard regression showed that those who did not initiate rifampin therapy were at higher risk of requiring revision for infection (hazard ratio: 2.22 [1.06 to 4.68]; =0.035). Of the 87 patients in this study, 18.4% had a DDI that contraindicated rifampin; however, only 3.4% had a DDI that contraindicated rifabutin.
This study supports that rifampin as combination therapy with DAIR or one-stage revision in staphylococcal PJI leads to better outcomes; however, its implementation is limited by DDIs. [. 2025;48(4):239-247.].
本研究评估了符合美国传染病学会利福平治疗指南的患者在治疗葡萄球菌人工关节感染（PJI）方面的结局，并探讨了在因药物相互作用（DDI）而禁忌使用利福平时，利福布汀作为替代药物的作用。
查询一家三级转诊中心的机构数据库，以获取2013年1月1日至2023年4月30日期间患有葡萄球菌PJI并接受清创和植入物保留手术（DAIR）或一期翻修的患者。患者按利福平治疗情况分层，并比较其PJI治疗成功的比率。收集所有患者的利福平和利福布汀DDI并进行比较。
在总共筛查的935例患者中，87例平均随访时间为4.4年的患者符合美国传染病学会利福平治疗指南。在完成利福平治疗的35例患者中，71.4%得到成功治疗。逻辑回归分析显示，未开始使用利福平治疗的患者成功治疗的可能性较小（比值比：0.76[0.60至0.97]；P = 0.031）。Cox比例风险回归显示，未开始使用利福平治疗的患者因感染需要翻修的风险更高（风险比：2.22[1.06至4.68]；P = 0.035）。在本研究的87例患者中，18.4%存在禁忌使用利福平的DDI；然而，只有3.4%存在禁忌使用利福布汀的DDI。
本研究支持利福平与DAIR或一期翻修联合治疗葡萄球菌PJI可带来更好的结局；然而，其应用受到DDI的限制。[《. 2025；48(4)：239 - 247》]
