Antibiotics | Investigating the Relationship Between the Timing of Postoperative Rifampicin Introduction and Clinical Outcomes in Orthopedic Implant Infections

This study retrospectively analyzed clinical and microbiological data from 103 patients with orthopedic implant-related Staphylococcus aureus and coagulase-negative staphylococcal infections, evaluating the impact of delayed rifampicin introduction on treatment failure, microbial recurrence, and rifampicin resistance. The results showed that a delay of approximately 5 days in rifampicin administration resulted in only a 1% resistance risk and did not affect clinical outcomes, providing important clinical evidence for the early use of rifampicin combination therapy.

 

Literature Overview
This paper, 'Evaluating the Link Between Postoperative Timing of Rifampicin Introduction and the Clinical and Microbiological Outcomes of Orthopedic Staphylococcal Implant Infections', published in the journal Antibiotics, reviews and summarizes the clinical and microbiological impacts of the timing of rifampicin introduction after orthopedic implant infections. The study included 103 patients treated between 2014 and 2024, assessing the relationship between rifampicin dosage, introduction timing, and the risks of treatment failure, recurrence, and drug resistance.

Background Knowledge
Orthopedic implant-related infections are among the serious postoperative complications, commonly caused by Staphylococcus aureus and coagulase-negative staphylococci. Due to the formation of biofilms by these bacteria, traditional antibiotics often fail to penetrate and eradicate the infection, leading to the frequent use of rifampicin combination therapy. However, rifampicin resistance develops rapidly, particularly during monotherapy or under high bacterial burden. Thus, clinical practice often delays its administration until wound closure. This study aims to evaluate whether delayed introduction of rifampicin affects clinical outcomes and to analyze its resistance mechanisms. The research background encompasses Staphylococcus aureus biofilm formation, postoperative antibiotic treatment strategies, and resistance-related gene mutations, challenging current clinical guidelines recommending delayed rifampicin use.

 

 

Research Methods and Experiments
The retrospective study included 103 patients with orthopedic implant-related staphylococcal infections treated between 2014 and 2024, analyzing the association between rifampicin introduction delay, dosage, duration of treatment, and outcomes such as clinical failure, microbiological recurrence, and resistance development. Cox regression analysis was employed to adjust for confounding variables and assess the impact of rifampicin use on treatment outcomes.

Key Conclusions and Perspectives

• Among the 103 infections, 47 were caused by Staphylococcus aureus and the remaining by coagulase-negative staphylococci.
• The median duration of postoperative systemic antibiotic therapy was 84 days, with a median rifampicin introduction time of 5 days post-surgery (IQR 3–8 days).
• Eighteen percent of patients discontinued rifampicin due to rifampicin-related adverse reactions, though no significant association was found between dosage and adverse effects.
• The clinical failure rate was 27%, and the microbiological recurrence rate with the same strain was 10%.
• Rifampicin resistance risk was 1%, with only one case developing resistance 68 days after treatment initiation, which occurred with an 8-day introduction delay, but this did not significantly affect outcomes.
• On multivariable Cox regression analysis, neither the delay in rifampicin introduction, dosage, nor duration of treatment significantly influenced clinical or microbiological outcomes.

Research Significance and Prospects
This study challenges the traditional belief that delaying rifampicin introduction reduces resistance risk. The findings suggest that early introduction of rifampicin combination therapy does not increase resistance risk or clinical failure rates. Future research should include prospective randomized controlled trials to validate the effectiveness of early rifampicin use across various surgical approaches and explore the relationship between rifampicin resistance mechanisms and host genotypes or bacterial strain clonality.

 

 

Conclusion
This study analyzed the timing of rifampicin introduction and its association with clinical and microbiological outcomes in orthopedic implant-related staphylococcal infections. The results indicate that delaying rifampicin treatment does not significantly reduce resistance or recurrence risks. Instead, early introduction of rifampicin combination therapy may enhance biofilm penetration and improve infection clearance. Despite limitations such as the retrospective design and relatively small sample size, the study provides important clinical evidence supporting the early use of rifampicin after surgery. These findings have significant implications for optimizing antibiotic strategies in clinical practice, particularly in the management of infections following open wounds or one-stage exchange procedures.

 

Valeria Dessert, Steven M Maurer, Marc S Maurer, Mazda Farshad, and İlker Uçkay. Evaluating the Link Between Postoperative Timing of Rifampicin Introduction and the Clinical and Microbiological Outcomes of Orthopedic Staphylococcal Implant Infections. Antibiotics.