Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis
Abstract Introduction Periprosthetic joint infections (PJI) are a major complication in joint-arthroplasty. Rifampicin is often used as an additional agent to treat PJI, because it penetrates bacterial biofilms. However, rifaximin, belonging to the same antibiotic class as rifampicin, is frequently...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-04-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-022-07379-2 |
| _version_ | 1828349246747705344 |
|---|---|
| author | Uta S. Koepf Sebastian Scheidt Gunnar T. R. Hischebeth Christian P. Strassburg Dieter C. Wirtz Thomas M. Randau Philipp Lutz |
| author_facet | Uta S. Koepf Sebastian Scheidt Gunnar T. R. Hischebeth Christian P. Strassburg Dieter C. Wirtz Thomas M. Randau Philipp Lutz |
| author_sort | Uta S. Koepf |
| collection | DOAJ |
| description | Abstract Introduction Periprosthetic joint infections (PJI) are a major complication in joint-arthroplasty. Rifampicin is often used as an additional agent to treat PJI, because it penetrates bacterial biofilms. However, rifaximin, belonging to the same antibiotic class as rifampicin, is frequently used to prevent episodes of hepatic encephalopathy in patients with cirrhosis and may induce resistance to rifampicin. The aim of this study was to examine the microbial pattern of periprosthetic joint infections in cirrhotic patients and to test the hypothesis that intake of rifaximin increases the rate of resistance to rifampicin in periprosthetic joint infections. Methods A cohort of cirrhotic patients and PJI (n = 25) was analysed on the characteristics of bacterial isolates from sonication and tissue analysis. In a second step a subgroup analysis on the development of rifampicin resistant bacterial specimens, depending on the intake of rifaximin (8 rifaximin intake patients vs. 13 non rifaximin intake patients) was performed. Results Intestinal bacteria were found in 50% of the specimens, which was significantly more frequent than in a control cohort. By comparison of the single bacterial isolates, rifampicin resistance was detected in 69.2% (9/13) of the rifaximin-intake samples. In contrast, the non-rifaximin-intake isolates only were resistant to rifampicin in 22.2% (4/18) of the cases (p = 0.01). The odds ratio for developing a rifampicin-resistance through rifaximin intake was calculated as OR = 13.5. Conclusion Periprosthetic joint infections have a high incidence of being caused by enteric bacteria in cirrhotic patients. Due to this change in microbial pattern and the innate resistance to rifampicin of most of gram-negative bacteria, the therapy with rifampicin should be carefully considered. The association between the use of rifaximin and developed resistance to rifampicin has a major impact on the treatment of PJI. |
| first_indexed | 2024-04-14T01:06:36Z |
| format | Article |
| id | doaj.art-cbb44de9b1014c598d639333f716bf49 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-14T01:06:36Z |
| publishDate | 2022-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-cbb44de9b1014c598d639333f716bf492022-12-22T02:21:13ZengBMCBMC Infectious Diseases1471-23342022-04-012211710.1186/s12879-022-07379-2Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosisUta S. Koepf0Sebastian Scheidt1Gunnar T. R. Hischebeth2Christian P. Strassburg3Dieter C. Wirtz4Thomas M. Randau5Philipp Lutz6Department of Internal Medicine I, University Hospital BonnDepartment of Orthopaedics and Traumatology, University Hospital BonnInstitute for Medical Microbiology, Immunology and Parasitology, University Hospital BonnDepartment of Internal Medicine I, University Hospital BonnDepartment of Orthopaedics and Traumatology, University Hospital BonnDepartment of Orthopaedics and Traumatology, University Hospital BonnDepartment of Internal Medicine I, University Hospital BonnAbstract Introduction Periprosthetic joint infections (PJI) are a major complication in joint-arthroplasty. Rifampicin is often used as an additional agent to treat PJI, because it penetrates bacterial biofilms. However, rifaximin, belonging to the same antibiotic class as rifampicin, is frequently used to prevent episodes of hepatic encephalopathy in patients with cirrhosis and may induce resistance to rifampicin. The aim of this study was to examine the microbial pattern of periprosthetic joint infections in cirrhotic patients and to test the hypothesis that intake of rifaximin increases the rate of resistance to rifampicin in periprosthetic joint infections. Methods A cohort of cirrhotic patients and PJI (n = 25) was analysed on the characteristics of bacterial isolates from sonication and tissue analysis. In a second step a subgroup analysis on the development of rifampicin resistant bacterial specimens, depending on the intake of rifaximin (8 rifaximin intake patients vs. 13 non rifaximin intake patients) was performed. Results Intestinal bacteria were found in 50% of the specimens, which was significantly more frequent than in a control cohort. By comparison of the single bacterial isolates, rifampicin resistance was detected in 69.2% (9/13) of the rifaximin-intake samples. In contrast, the non-rifaximin-intake isolates only were resistant to rifampicin in 22.2% (4/18) of the cases (p = 0.01). The odds ratio for developing a rifampicin-resistance through rifaximin intake was calculated as OR = 13.5. Conclusion Periprosthetic joint infections have a high incidence of being caused by enteric bacteria in cirrhotic patients. Due to this change in microbial pattern and the innate resistance to rifampicin of most of gram-negative bacteria, the therapy with rifampicin should be carefully considered. The association between the use of rifaximin and developed resistance to rifampicin has a major impact on the treatment of PJI.https://doi.org/10.1186/s12879-022-07379-2PJIRifampicinRifaximinEnteric bacteriaLiver cirrhosisTKA |
| spellingShingle | Uta S. Koepf Sebastian Scheidt Gunnar T. R. Hischebeth Christian P. Strassburg Dieter C. Wirtz Thomas M. Randau Philipp Lutz Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis BMC Infectious Diseases PJI Rifampicin Rifaximin Enteric bacteria Liver cirrhosis TKA |
| title | Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis |
| title_full | Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis |
| title_fullStr | Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis |
| title_full_unstemmed | Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis |
| title_short | Increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis |
| title_sort | increased rate of enteric bacteria as cause of periprosthetic joint infections in patients with liver cirrhosis |
| topic | PJI Rifampicin Rifaximin Enteric bacteria Liver cirrhosis TKA |
| url | https://doi.org/10.1186/s12879-022-07379-2 |
| work_keys_str_mv | AT utaskoepf increasedrateofentericbacteriaascauseofperiprostheticjointinfectionsinpatientswithlivercirrhosis AT sebastianscheidt increasedrateofentericbacteriaascauseofperiprostheticjointinfectionsinpatientswithlivercirrhosis AT gunnartrhischebeth increasedrateofentericbacteriaascauseofperiprostheticjointinfectionsinpatientswithlivercirrhosis AT christianpstrassburg increasedrateofentericbacteriaascauseofperiprostheticjointinfectionsinpatientswithlivercirrhosis AT dietercwirtz increasedrateofentericbacteriaascauseofperiprostheticjointinfectionsinpatientswithlivercirrhosis AT thomasmrandau increasedrateofentericbacteriaascauseofperiprostheticjointinfectionsinpatientswithlivercirrhosis AT philipplutz increasedrateofentericbacteriaascauseofperiprostheticjointinfectionsinpatientswithlivercirrhosis |