Zhang Canhong, Li Juncheng, Lin Lan, Liu Mingzhong, Chen Yang, Cai Yuanqing, Huang Jiexin, Huang Zida, Zhang Chaofan, Zhang Wenming, Fang Xinyu, Li Wenbo
Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Orthopaedic Surgery, National Regional Medical Center, Fujian Medical University, Fuzhou, China.
Front Cell Infect Microbiol. 2025 Jul 16;15:1587436. doi: 10.3389/fcimb.2025.1587436. eCollection 2025.
The purpose of this study was to evaluate the impact of adjunctive rifampicin therapy on the outcomes of prosthesis retention versus removal in patients with staphylococcal prosthetic joint infection (PJI) undergoing antibacterial treatment.
A retrospective study was conducted on 227 patients diagnosed with Staphylococcal PJI from March 2014 to September 2023 who underwent debridement, antibiotics, and implant retention (DAIR) or explantation and revision surgery. Based on antimicrobial susceptibility testing, we used an effective baseline antibiotic regimen. We defined the combination of this regimen with rifampicin as the "rifampicin treatment group" and the regimen without rifampicin as the "non-rifampicin treatment group".
A total of 79 patients were included in the rifampin treatment group and 148 in the non-rifampin treatment group. There was no significant difference in the remission rate of PJI between the rifampin treatment group and the non-rifampin treatment group (79.75% vs 73.65%, p = 0.083). Additionally, Kaplan-Meier survival curve analysis showed no statistically significant difference between the two groups (p = 0.509). However, the incidence of drug-related adverse events was significantly higher in the rifampin treatment group compared to the non-rifampin treatment group (31.65% vs 8.78%, p < 0.001). There were no significant difference in treatment success rates between the use and non-use of rifampin in DAIR, one-stage revision, or two-stage revision, as well as in hip or knee joints. Binary logistic regression analysis identified diabetes and active smoking as independent significant risk factors for treatment failure, while rifampin was not an independent risk factor affecting the outcome.
The study has not demonstrated that the standard antibiotic regimen combined with rifampin has a significant effect on the efficacy of retaining or removing prostheses in staphylococcal PJI, but rather increases drug-related adverse events. Standard surgical procedures, accurate pathogen diagnosis, and treatment are particularly crucial in the management of PJI.
本研究旨在评估辅助利福平治疗对接受抗菌治疗的葡萄球菌性人工关节感染（PJI）患者假体保留与移除结局的影响。
对2014年3月至2023年9月期间诊断为葡萄球菌性PJI并接受清创、抗生素治疗和植入物保留（DAIR）或取出及翻修手术的227例患者进行回顾性研究。根据药敏试验，我们采用了有效的基线抗生素方案。我们将该方案与利福平的联合用药定义为“利福平治疗组”，将不使用利福平的方案定义为“非利福平治疗组”。
利福平治疗组共纳入79例患者，非利福平治疗组纳入148例患者。利福平治疗组与非利福平治疗组PJI缓解率无显著差异（79.75%对73.65%，p = 0.083）。此外，Kaplan-Meier生存曲线分析显示两组之间无统计学显著差异（p = 0.509）。然而，利福平治疗组药物相关不良事件的发生率显著高于非利福平治疗组（31.65%对8.78%，p < 0.001）。在DAIR、一期翻修或二期翻修中，以及在髋关节或膝关节中，使用利福平和不使用利福平的治疗成功率无显著差异。二元逻辑回归分析确定糖尿病和主动吸烟是治疗失败的独立显著危险因素，而利福平不是影响结局的独立危险因素。
该研究未证明标准抗生素方案联合利福平对葡萄球菌性PJI患者假体保留或移除的疗效有显著影响，反而增加了药物相关不良事件。标准手术程序、准确的病原体诊断和治疗在PJI的管理中尤为关键。
