title: Outcome of debridement and retention in prosthetic joint infections by methicillin-resistant staphylococci, with special reference to rifampin and fusidic acid combination therapy.
abstract: The management of prosthetic joint infections remains a clinical challenge, particularly infections due to methicillin-resistant staphylococci. Previously, this infection was considered a contraindication to debridement and retention strategies. This retrospective cohort study examined the treatment and outcomes of patients with arthroplasty infection by methicillin-resistant staphylococci managed by debridement and retention in conjunction with rifampin-fusidic acid combination therapy. Over an 11-year period, there were 43 patients with infection by methicillin-resistant staphylococci managed with debridement and retention. This consisted of close-interval repeated arthrotomies with pulsatile lavage. Rifampin was combined with fusidic acid for the majority of patients (88%). Patients were monitored for a median of 33.5 months (interquartile range, 20 to 54 months). Overall, 9 patients experienced treatment failure, with 12- and 24-month estimates of infection-free survival of 86% (95% confidence interval [CI], 71 to 93%) and 77% (95% CI, 60 to 87%), respectively. The following factors were associated with treatment failure: methicillin-resistant Staphylococcus aureus (MRSA) arthroplasty infection, a single surgical debridement or ≥4 debridements, and the receipt of less than 90 days of antibiotic therapy. Patients with infection by methicillin-resistant coagulase-negative staphylococci (MR-CNS) were less likely to fail treatment. The overall treatment success rate reported in this study is comparable to those of other treatment modalities for prosthetic joint infections by methicillin-resistant staphylococci. Therefore, the debridement and retention of the prosthesis and rifampin-based antibiotic therapy are a valid treatment option for carefully selected patients.
authors.affiliation: Department of Infectious Diseases, St. Vincent's Hospital, Melbourne, Victoria, Australia. tpeel@student.unimelb.edu.au
authors.forename: T N
authors.initials: TN
authors.lastname: Peel
authors.forename: K L
authors.initials: KL
authors.lastname: Buising
authors.forename: M M
authors.initials: MM
authors.lastname: Dowsey
authors.forename: C A
authors.initials: CA
authors.lastname: Aboltins
authors.forename: J R
authors.initials: JR
authors.lastname: Daffy
authors.forename: P A
authors.initials: PA
authors.lastname: Stanley
authors.forename: P F M
authors.initials: PF
authors.lastname: Choong
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001178:Arthroplasty; D003646:Debridement / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D005672:Fusidic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007595:Joint Prosthesis / Q000382:microbiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D005672:Fusidic Acid; D012293:Rifampin