Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been Exchanged? A Multicenter Observational Cohort Study

To  The editor—We would like to thank the author for his interest in our research and for his comments regarding our article titled “Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been Exchanged? A Multicenter Observational Cohort Study.”

We fully agree and are aware that small-colony variants (SCVs) can play an important role in staphylococcal periprosthetic joint infections (PJIs). Future studies should record this variable and investigate its impact based on species, chosen antibiotics, and outcome.

Clinical microbiologists should reach consensus on how to report information on SCVs in a structured form to clinicians. However, it is important to note that the absence of SCVs in culture does not rule out intracellular staphylococci.

In this study, we focused on cases of PJI that were treated with a total exchange of joint prothesis (1-stage or 2-stage) independant of a previous failure. The benefit of rifampicin was observed in patients with chronic infections treated with a 2-stage exchange. Total exchange followed by antibiotic treatment is widely accepted and used as a definitive treatment strategy. S. aureus was more frequent in the group not receiving rifampicin, and an infection with S. aureus that led to the explantation was identified as a independant risk factor for failure. The same is true for the use of rifampicin.

Our findings suggest that future studies should evaluate the additional effect on intracellular antibiotics (such as rifampicin) for PJI with S. aureus when no foreign bodies are present.

Acknowledgments

Collaborators. Rares Mircea Birlutiu, Marc Trojanowski, Lansing Sugita, Haijun Xu, Montserrat Sanmarti Vilamala, Laura Morata, Luisa Sorli, Juan Pablo Horcajada, Marie Dorel, Nicolo Rossi, Ashley Barnes, Björn Wandhoff, Vincent Derdour.

Author notes