Rifampin is one of the most important biofilm-active antibiotics in the treatment of periprosthetic joint infection (PJI), and antibiotic regimens not involving rifampin were shown to have higher failure rates. Therefore, an emerging rifampin resistance can have a devastating effect on the outcome of PJI. The aim of this study was to compare the incidence of rifampin resistance between two groups of patients with a PJI treated with antibiotic regimens involving either immediate or delayed additional rifampin administration and to evaluate the effect of this resistance on the outcome. In this retrospective analysis of routinely collected data, all patients who presented with an acute/chronic PJI between 2018 and 2020 were recorded in the context of a single-center comparative cohort study. Two groups were formed: Group 1 included 25 patients with a PJI presenting in 2018–2019. These patients received additional rifampin only after pathogen detection in the intraoperative specimens. Group 2 included 37 patients presenting in 2019–2020. These patients were treated directly postoperatively with an empiric antibiotic therapy including rifampin. In all, 62 patients (32 females) with a mean age of 68 years and 322 operations were included. We found a rifampin-resistant organism in 16% of cases. Rifampin resistance increased significantly from 12% in Group 1 to 19% in Group 2 (p < 0.05). The treatment failure rate was 16% in Group 1 and 16.2% in Group 2 (p = 0.83). The most commonly isolated rifampin-resistant pathogen was Staphylococcus epidermidis (86%) (p < 0.05). The present study shows a significant association between the immediate start of rifampin after surgical revision in the treatment of PJI and the emergence of rifampin resistance, however with no significant effect on outcome.

中文翻译：

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在假体周围关节感染的抗生素治疗中延迟利福平给药显着减少利福平耐药性的出现

利福平是治疗假体周围关节感染 (PJI) 中最重要的生物膜活性抗生素之一，且不涉及利福平的抗生素方案被证明具有更高的失败率。因此，新出现的利福平耐药性会对 PJI 的结果产生破坏性影响。本研究的目的是比较两组 PJI 患者的利福平耐药发生率，这些患者接受抗生素方案治疗，包括立即或延迟额外利福平给药，并评估这种耐药性对结果的影响。在这项对常规收集数据的回顾性分析中，所有在 2018 年至 2020 年期间出现急性/慢性 PJI 的患者都被记录在一项单中心比较队列研究的背景下。成立了两个小组：第 1 组包括 25 名在 2018-2019 年出现 PJI 的患者。这些患者仅在术中标本中检测到病原体后才接受额外的利福平。第 2 组包括 37 名在 2019-2020 年就诊的患者。这些患者术后直接接受经验性抗生素治疗，包括利福平。共纳入 62 名患者（32 名女性），平均年龄为 68 岁，进行了 322 次手术。我们在 16% 的病例中发现了利福平耐药菌。利福平耐药性从第 1 组的 12% 显着增加到第 2 组的 19%（这些患者术后直接接受经验性抗生素治疗，包括利福平。共纳入 62 名患者（32 名女性），平均年龄为 68 岁，进行了 322 次手术。我们在 16% 的病例中发现了利福平耐药菌。利福平耐药性从第 1 组的 12% 显着增加到第 2 组的 19%（这些患者术后直接接受经验性抗生素治疗，包括利福平。共纳入 62 名患者（32 名女性），平均年龄为 68 岁，进行了 322 次手术。我们在 16% 的病例中发现了利福平耐药菌。利福平耐药性从第 1 组的 12% 显着增加到第 2 组的 19%（p < 0.05)。第 1 组的治疗失败率为 16%，第 2 组为 16.2%（p = 0.83）。最常分离到的利福平耐药病原体是表皮葡萄球菌(86%) ( p < 0.05)。目前的研究表明，在 PJI 手术修复后立即开始使用利福平与出现利福平耐药之间存在显着关联，但对结果没有显着影响。