Impact of rifampicin dose in bone and joint prosthetic device infections due to Staphylococcus spp: a retrospective single-center study in France

M Tonnelier,Y El Samad,J-P Lanoix,A Bouras,C Mabille,B Brunschweiler,J.-L Schmit,C Joseph

doi:10.1186/s12879-021-05832-2

Abstract

BackgroundProsthetic joint infections (PJI) are a major cause of morbidity and mortality burden worldwide. While surgical management is well defined, rifampicin (RIF) dose remains controversial. The aim of our study was to determine whether Rifampicin dose impact infection outcomes in PJI due to Staphylococcus spp.Methodssingle-center retrospective study including 411 patients with PJI due to Rifampicin-sensitive Staphylococcus spp. Rifampicine dose was categorized as follow: < 10 mg/kg/day, 10–20 mg/kg/day or > 20 mg/kg/day. The primary endpoint was patient recovery, defined as being free of infection during 12 months after the end of the initial antibiotic course.Results321 (78%) received RIF for the full antibiotic course. RIF dose didn’t affect patients recovery rate with 67, 76 and 69% in the < 10, 10–20 and > 20 mg/kg/day groups, respectively (p = 0.083). In univariate analysis, recovery rate was significantly associated with gender (p = 0.012) but not to RIF dose, or Staphylococcus phenotype (aureus or coagulase-negative). In multivariate analysis, age (p = 0.01) and treatment duration (p < 0.01) were significantly associated with recovery rate.ConclusionThese data suggest that lower doses of RIF are as efficient and safe as the recommended high-dose French regimen in the treatment of PJI.

Highlights

Prosthetic joint infections (PJI) are a major cause of morbidity and mortality burden worldwide
The ideal RIF dose for PJI is not clearly defined, varying from 5 to 20 mg/kg/day depending on the Tonnelier et al BMC Infectious Diseases (2021) 21:174 study [12,13,14,15]
From January 2008 until December 2018, 837 patients were treated for PJI due to Staphylococcus spp. (Fig. 1)

Summary

Introduction

Prosthetic joint infections (PJI) are a major cause of morbidity and mortality burden worldwide. The disease burden of bone and joint prosthetic device infections (PJI) is high [1,2,3], because of a need for intensive care in 6% of cases and an estimated inhospital lethality of 5% [4], increasing with age. For PJI due to sensitive germs, Rifampicin (RIF) is a cornerstone, owing to its high bone and tissue diffusion and its action in biofilm [7, 8]. The ideal RIF dose for PJI is not clearly defined, varying from 5 to 20 mg/kg/day depending on the Tonnelier et al BMC Infectious Diseases (2021) 21:174 study [12,13,14,15]. The 2009 French guidelines suggested 10 mg/kg of RIF twice a day (i.e. 20 mg/kg/day) [9], whereas American guidelines (2013) did not take patient weight into account and recommended lower doses of 600 to 900 mg daily, taken once or twice (i.e. 8-12 mg/kg/day for a standard 75 kg person) [14]

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