Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients
Background. Rifampicin is a pillar in the treatment of periprosthetic joint infection (PJI). However, rifampicin resistance is an increasing threat to PJI treatment. This study explores the incidence of rifampicin-resistant bacteria over time in a Swedish tertiary referral centre and the association...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-09-01
|
| Series: | Antibiotics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2079-6382/12/10/1499 |
| _version_ | 1828715154623168512 |
|---|---|
| author | Stergios Lazarinis Nils P. Hailer Josef D. Järhult Anders Brüggemann |
| author_facet | Stergios Lazarinis Nils P. Hailer Josef D. Järhult Anders Brüggemann |
| author_sort | Stergios Lazarinis |
| collection | DOAJ |
| description | Background. Rifampicin is a pillar in the treatment of periprosthetic joint infection (PJI). However, rifampicin resistance is an increasing threat to PJI treatment. This study explores the incidence of rifampicin-resistant bacteria over time in a Swedish tertiary referral centre and the association of rifampicin resistance with infection-free survival after PJI. Methods. The study included 238 staphylococcal PJIs treated between 2001 and 2020 for which susceptibility data for rifampicin were available. Data on causative bacteria, rifampicin resistance, treatment, and outcome were obtained. Kaplan–Meier survival analysis and Cox regression modelling estimated the infection-free cumulative survival and adjusted hazard ratios (HRs) for the risk of treatment failure. Results. Rifampicin-resistant causative bacteria were identified in 40 cases (17%). The proportion of rifampicin-resistant agents decreased from 24% in 2010–2015 to 12% in 2016–2020. The 2-year infection-free survival rates were 78.6% (95% CI, 66.4–93.1%) for the rifampicin-resistant group and 90.0% (95% CI, 85.8–94.4%) for the rifampicin-sensitive group. Patients with PJI caused by rifampicin-resistant bacteria had an increased risk of treatment failure (adjusted HR, 4.2; 95% CI, 1.7–10.3). Conclusions. The incidence of PJI caused by rifampicin-resistant bacteria did not increase over the past 20 years. The risk of treatment failure in PJI caused by rifampicin-resistant bacteria is more than four times that caused by rifampicin-sensitive bacteria, highlighting the importance of limiting the development of rifampicin resistance. |
| first_indexed | 2024-03-10T21:29:51Z |
| format | Article |
| id | doaj.art-e488f4c6fc174ffe80d08b69aab84986 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T21:29:51Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-e488f4c6fc174ffe80d08b69aab849862023-11-19T15:26:21ZengMDPI AGAntibiotics2079-63822023-09-011210149910.3390/antibiotics12101499Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 PatientsStergios Lazarinis0Nils P. Hailer1Josef D. Järhult2Anders Brüggemann3Department of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, SwedenDepartment of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, SwedenDepartment of Medical Sciences, Zoonosis Science Center, Uppsala University, SE-751 85 Uppsala, SwedenDepartment of Surgical Sciences, Orthopaedics, Uppsala University, SE-751 85 Uppsala, SwedenBackground. Rifampicin is a pillar in the treatment of periprosthetic joint infection (PJI). However, rifampicin resistance is an increasing threat to PJI treatment. This study explores the incidence of rifampicin-resistant bacteria over time in a Swedish tertiary referral centre and the association of rifampicin resistance with infection-free survival after PJI. Methods. The study included 238 staphylococcal PJIs treated between 2001 and 2020 for which susceptibility data for rifampicin were available. Data on causative bacteria, rifampicin resistance, treatment, and outcome were obtained. Kaplan–Meier survival analysis and Cox regression modelling estimated the infection-free cumulative survival and adjusted hazard ratios (HRs) for the risk of treatment failure. Results. Rifampicin-resistant causative bacteria were identified in 40 cases (17%). The proportion of rifampicin-resistant agents decreased from 24% in 2010–2015 to 12% in 2016–2020. The 2-year infection-free survival rates were 78.6% (95% CI, 66.4–93.1%) for the rifampicin-resistant group and 90.0% (95% CI, 85.8–94.4%) for the rifampicin-sensitive group. Patients with PJI caused by rifampicin-resistant bacteria had an increased risk of treatment failure (adjusted HR, 4.2; 95% CI, 1.7–10.3). Conclusions. The incidence of PJI caused by rifampicin-resistant bacteria did not increase over the past 20 years. The risk of treatment failure in PJI caused by rifampicin-resistant bacteria is more than four times that caused by rifampicin-sensitive bacteria, highlighting the importance of limiting the development of rifampicin resistance.https://www.mdpi.com/2079-6382/12/10/1499incidenceperiprosthetic joint infectionrifampicin resistancetreatment failure |
| spellingShingle | Stergios Lazarinis Nils P. Hailer Josef D. Järhult Anders Brüggemann Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients Antibiotics incidence periprosthetic joint infection rifampicin resistance treatment failure |
| title | Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients |
| title_full | Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients |
| title_fullStr | Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients |
| title_full_unstemmed | Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients |
| title_short | Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients |
| title_sort | incidence of rifampicin resistance in periprosthetic joint infection a single centre cohort study on 238 patients |
| topic | incidence periprosthetic joint infection rifampicin resistance treatment failure |
| url | https://www.mdpi.com/2079-6382/12/10/1499 |
| work_keys_str_mv | AT stergioslazarinis incidenceofrifampicinresistanceinperiprostheticjointinfectionasinglecentrecohortstudyon238patients AT nilsphailer incidenceofrifampicinresistanceinperiprostheticjointinfectionasinglecentrecohortstudyon238patients AT josefdjarhult incidenceofrifampicinresistanceinperiprostheticjointinfectionasinglecentrecohortstudyon238patients AT andersbruggemann incidenceofrifampicinresistanceinperiprostheticjointinfectionasinglecentrecohortstudyon238patients |