Prosthetic Shoulder Joint Infection by <em>Cutibacterium acnes</em>: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study
Helem H. Vilchez,
Rosa Escudero-Sanchez,
Marta Fernandez-Sampedro,
Oscar Murillo,
Álvaro Auñón,
Dolors Rodríguez-Pardo,
Alfredo Jover-Sáenz,
Mª Dolores del Toro,
Alicia Rico,
Luis Falgueras,
Julia Praena-Segovia,
Laura Guío,
José A. Iribarren,
Jaime Lora-Tamayo,
Natividad Benito,
Laura Morata,
Antonio Ramirez,
Melchor Riera,
Study Group on Osteoarticular Infections (GEIO),
the Spanish Network for Research in Infectious Pathology (REIPI)
Affiliations
Helem H. Vilchez
Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
Mª Dolores del Toro
Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena CSIC, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, 41009 Sevilla, Spain
Alicia Rico
Infectious Diseases Unit and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain
Infectious Diseases Department, Hospital Universitario Donostia, Instituto BioDonostia, 20014 San Sebastián, Spain
Jaime Lora-Tamayo
Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre “i + 12”, 28041 Madrid, Spain
Natividad Benito
Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d’Investigació Biomèdica Sant Pau, Departament of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain
Laura Morata
Department of Infectious Diseases, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
Antonio Ramirez
Microbiologic Department, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain
Melchor Riera
Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain
Study Group on Osteoarticular Infections (GEIO)
the Spanish Network for Research in Infectious Pathology (REIPI)
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.
