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Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study

2021; Multidisciplinary Digital Publishing Institute; Volume: 10; Issue: 5 Linguagem: Inglês

10.3390/antibiotics10050475

2079-6382

Helem Vílchez, Rosa Escudero-Sánchez, Marta Fernández-Sampedro, Óscar Murillo, Álvaro Auñón, Dolors Rodríguez-Pardo, A Jover, María Dolores del Toro, Alicia Rico, Luis Falgueras, Julia Praena‐Segovia, Laura Guío Carrión, José Iribarren, Jaime Lora-Tamayo, Natividad Benito, Laura Morata, Antonio J. Ramírez, Melchor Riera,

Infectious Diseases and Tuberculosis

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3–75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80–58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08–105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.