Rifampin for Prosthetic Joint Infections: Lessons Learned Over 20 Years at a VA Medical Center

Background: The Minneapolis Veterans Affairs Health Care System uses debridement and implant retention (DAIR) combined with oral rifampin and a second antibiotic to treat orthopedic implant infections. However, the success rate of this approach in a veteran population is unknown. Methods: We performed a retrospective analysis of patients who underwent DAIR with a rifampin-containing regimen for an orthopedic implant infection over the past 20 years at the Minneapolis Veterans Affairs Health Care System. The primary outcome was treatment success among participants who were treated with curative intent, defined as planned device retention without ongoing antibiotic use. Secondary outcomes were treatment harms and therapy duration. Treatment success was defined as the absence of recurrent infection or further measures to suppress infection within 1 year of completing antimicrobial therapy. Results: A total of 78 patients (88% male) were included (median age, 65.5 years), with 50 treated with curative intent (primary analysis group). Forty-one participants (82%) in the curative intent group experienced treatment success. The success rate was higher among participants whose implant was < 2 months old vs those whose implant was ≥ 2 months old (93% vs 65%, respectively; P = .02). The 28 participants treated without curative intent had more comorbidities, higher rates of chronic infection, and older implants than those treated with curative intent. Conclusions: Veterans with orthopedic implant infections can be successfully treated with DAIR combined with a rifampin-containing antimicrobial regimen. Success is highest for patients with a recent implant. Debridement and implant retention using regimens that include rifampin is an evidence-based strategy for managing patients with infected prosthetic hardware. Here we report that this approach is feasible in a veteran population, especially with recently implanted prosthetic material.