Effectiveness of rifampicin combination therapy for orthopaedic implant-related infections: A systematic review and meta-analysis

IF 4.9 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Antimicrobial Agents Pub Date : 2024-10-18 DOI:10.1016/j.ijantimicag.2024.107359

Naomi Kobayashi , Kazuhiko Matsushita , Emi Kamono , Hiroshi Matsumoto , Natsumi Saka , Katsufumi Uchiyama , Kai Suzuki , Yui Akiyama , Hiroyuki Onuma , Koji Yamada

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引用次数: 0

Abstract

Background

In vitro, animal, and clinical comparative studies have revealed that combinations of rifampicin with antibacterial agents are effective in the treatment of biofilm-associated infections. This study aimed to assess the effectiveness of rifampicin combination therapies compared with monotherapies without rifampicin in patients with orthopaedic implant-related infections.

Materials and Methods

The clinical literature was comprehensively searched for studies assessing the effectiveness of rifampicin combination therapy in patients with orthopaedic implant-related infection. Identified studies were screened based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram. The primary outcome was the cure rate and the secondary outcome was the incidence of adverse events. Subgroup analyses were performed based on causative organisms, antibacterial agents, and types of surgical intervention.

Results

Twenty-seven studies were identified, including two randomized controlled trials (RCTs) and 25 cohort studies. Rifampicin combinations were associated with significantly higher cure rates than monotherapies in cohort studies, but not in RCTs. Subgroup analyses showed that rifampicin combinations were effective in patients infected with Cutibacterium and Staphylococcus spp.; in patients who underwent debridement, antibiotics, implant retention procedures; and in patients with one-stage revision. Moreover, combinations of rifampicin and fluoroquinolones were more effective than fluoroquinolones alone, while combinating rifampicin with other antibacterial agents showed no significant benefit. Combination treatment did not significantly affect adverse events in either RCTs or observational studies. Risk of bias assessment and summary of findings showed that the certainty of evidence for both RCTs and observational studies was very low.

Conclusions

This systematic review and meta-analysis confirmed the potential effectiveness of rifampicin combination therapy for the cure of orthopaedic implant-related infection in some circumstances, although the certainty and quality of evidence were very low.

查看原文本刊更多论文

利福平联合疗法对骨科植入物相关感染的疗效：系统回顾和荟萃分析。

背景：体外、动物和临床对比研究显示，利福平与抗菌药联合使用可有效治疗生物膜相关感染。本研究旨在评估利福平联合疗法与不含利福平的单一疗法相比，对骨科植入物相关感染患者的疗效：在临床文献中全面检索了评估利福平联合疗法对骨科植入物相关感染患者疗效的研究。根据 PRISMA 流程图筛选出的研究。主要结果为治愈率，次要结果为不良事件发生率。根据致病菌、抗菌药物和手术干预类型进行了分组分析：共确定了 27 项研究，包括 2 项随机对照试验 (RCT) 和 25 项队列研究。在队列研究中，利福平联合用药的治愈率明显高于单一疗法，但在随机对照试验中则不然。亚组分析表明，利福平联合疗法对感染 Cutibacterium 和 Staphylococcus spp.的患者、接受清创、抗生素、植入物保留（DAIR）手术的患者以及一期翻修的患者有效。此外，利福平与氟喹诺酮类药物的联合用药比单独使用氟喹诺酮类药物更有效，而利福平与其他抗菌药物的联合用药则无明显疗效。在研究性试验或观察性研究中，联合治疗对不良事件的影响都不大。偏倚风险评估和研究结果摘要显示，研究性试验和观察性研究的证据确定性都很低：这项系统综述和荟萃分析证实了利福平联合疗法在某些情况下治疗骨科植入物相关感染的潜在有效性，尽管证据的确定性和质量都很低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Antimicrobial Agents 医学-传染病学

CiteScore

21.60

自引率

0.90%

发文量

176

审稿时长

36 days

期刊介绍： The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.