Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis

H Scheper, L M Gerritsen, B G Pijls, S A Van Asten, L G Visser, M G J De Boer, H Scheper, L M Gerritsen, B G Pijls, S A Van Asten, L G Visser, M G J De Boer

Abstract

The treatment of staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics, and retention of the implant (DAIR) often results in failure. An important evidence gap concerns the treatment with rifampicin for PJI. A systematic review and meta-analysis were conducted to assess the outcome of staphylococcal hip and/or knee PJI after DAIR, focused on the role of rifampicin. Studies published until September 2, 2020 were included. Success rates were stratified for type of joint and type of micro-organism. Sixty-four studies were included. The pooled risk ratio for rifampicin effectiveness was 1.10 (95% confidence interval, 1.00-1.22). The pooled success rate was 69% for Staphylococcus aureus hip PJI, 54% for S aureus knee PJI, 83% for coagulase-negative staphylococci (CNS) hip PJI, and 73% for CNS knee PJI. Success rates for MRSA PJI (58%) were similar to MSSA PJI (60%). The meta-analysis indicates that rifampicin may only prevent a small fraction of all treatment failures.

Keywords: DAIR; meta-analysis; rifampicin; staphylococcal PJI; systematic review.

© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Flow chart of study selection. m.o., micro-organism; PJI, prosthetic joint infection; RCT, randomized controlled trial.
Figure 2.
Figure 2.
Relation between study size and outcome of staphylococcal prosthetic joint infection) treated with debridement, antibiotics, and retention of the implant (DAIR) (n = 64 studies).
Figure 3.
Figure 3.
Success rates in 39 studies that could be categorized by knee-to-hip-ratio. CI, confidence interval; RR, risk ratio.
Figure 4.
Figure 4.
Success rates over the years for staphylococcal prosthetic joint infection treated with debridement, antibiotics, and retention of the implant (DAIR) and related to use of rifampicin. Different bubble sizes represent differences in study size.
Figure 5.
Figure 5.
Meta-analysis of 11 studies in which outcome for staphylococcal prosthetic joint infection (PJI) after debridement, antibiotics, and retention of the implant (DAIR) could be compared between patients treated and not treated with rifampicin. The point estimate (relative risk) for each study is represented by a square. The 95% confidence interval (CI) for each study is represented by a horizontal line intersecting the square. The size of the square represents the relative precision of the study estimates: the bigger the square, the more precise the study.

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