The impact of surgical strategy and rifampin on treatment outcome in Cutibacterium periprosthetic joint infections.

Achermann, Yvonne; Kusejko, Katharina; Auñón, Álvaro; Clauss, Martin; Corvec, Stéphane; Esteban, Jaime; Fernandez-Sampedro, Marta; Ferrari, Matteo Carlo; Gassmann, Natalie; Jent, Philipp; Jost, Bernhard; Kouyos, Roger D; Kramer, Tobias Siegfried; Lora-Tamayo, Jaime; Morand, Philippe C; Benito, Natividad; Pablo-Marcos, Daniel; Patel, Robin; Scanferla, Giulia; Sendi, Parham; ... (2021). The impact of surgical strategy and rifampin on treatment outcome in Cutibacterium periprosthetic joint infections. Clinical infectious diseases, 72(12), e1064-e1073. Oxford University Press 10.1093/cid/ciaa1839

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Cutibacterium species are common pathogens in periprosthetic joint infections (PJI). These infections are often treated with β-lactams or clindamycin as monotherapy, or in combination with rifampin. Clinical evidence supporting the value of adding rifampin for treatment of Cutibacterium PJI is lacking.


In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection within a minimal follow-up of 12 months. We used Fisher's exact tests and Cox proportional hazards models to analyze the effect of rifampin and other factors on clinical success after PJI.


We included 187 patients (72.2% male, median age 67 years) with a median follow-up of 36 months. The surgical intervention was two-stage exchange in 95 (50.8%), one-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%). Rifampin was included in the antibiotic regimen in 81 (43.3%) cases. Infection relapse occurred in 28 (15.0%), and new infection in 13 (7.0%) cases. In the time-to-event analysis, DAIR (adjusted HR=2.15, p=0.03) and antibiotic treatment over 6 weeks (adjusted HR=0.29, p=0.0002) significantly influenced treatment failure. We observed a tentative evidence for a beneficial effect of adding rifampin to the antibiotic treatment - though not statistically significant for treatment failure (adjusted HR=0.5, p=0.07) and not for relapses (adjusted HR=0.5, p=0.10).


We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI but a dedicated prospective multicenter study is needed.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Jent, Philipp, Thurnheer Zürcher, Maria Christine


600 Technology > 610 Medicine & health




Oxford University Press




Annelies Luginbühl

Date Deposited:

13 Jan 2021 14:28

Last Modified:

05 Dec 2022 15:43

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Cutibacterium species, Propionibacterium species, Periprosthetic joint infections, antibiotic treatment, rifampin




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