清创、抗生素及保留植入物治疗金黄色葡萄球菌性髋膝关节假体周围感染的疗效，重点关注利福平的使用：一项系统评价与荟萃分析

Outcome of Debridement, Antibiotics, and Implant Retention for Staphylococcal Hip and Knee Prosthetic Joint Infections, Focused on Rifampicin Use: A Systematic Review and Meta-Analysis.

作者信息

Scheper H, Gerritsen L M, Pijls B G, Van Asten S A, Visser L G, De Boer M G J

机构信息

Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.

Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands.

出版信息

Open Forum Infect Dis. 2021 Jul 1;8(7):ofab298. doi: 10.1093/ofid/ofab298. eCollection 2021 Jul.

The treatment of staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics, and retention of the implant (DAIR) often results in failure. An important evidence gap concerns the treatment with rifampicin for PJI. A systematic review and meta-analysis were conducted to assess the outcome of staphylococcal hip and/or knee PJI after DAIR, focused on the role of rifampicin. Studies published until September 2, 2020 were included. Success rates were stratified for type of joint and type of micro-organism. Sixty-four studies were included. The pooled risk ratio for rifampicin effectiveness was 1.10 (95% confidence interval, 1.00-1.22). The pooled success rate was 69% for hip PJI, 54% for knee PJI, 83% for coagulase-negative staphylococci (CNS) hip PJI, and 73% for CNS knee PJI. Success rates for MRSA PJI (58%) were similar to MSSA PJI (60%). The meta-analysis indicates that rifampicin may only prevent a small fraction of all treatment failures.

采用清创、抗生素及保留植入物（DAIR）治疗金黄色葡萄球菌假体关节感染（PJI）常常导致治疗失败。关于利福平治疗PJI存在一个重要的证据空白。开展了一项系统评价和荟萃分析，以评估DAIR后金黄色葡萄球菌性髋和/或膝PJI的治疗结果，重点关注利福平的作用。纳入截至2020年9月2日发表的研究。成功率按关节类型和微生物类型进行分层。共纳入64项研究。利福平有效性的合并风险比为1.10（95%置信区间，1.00 - 1.22）。髋PJI的合并成功率为69%，膝PJI为54%，凝固酶阴性葡萄球菌（CNS）性髋PJI为83%，CNS性膝PJI为73%。耐甲氧西林金黄色葡萄球菌（MRSA）PJI的成功率（58%）与甲氧西林敏感金黄色葡萄球菌（MSSA）PJI（60%）相似。荟萃分析表明，利福平可能仅能预防所有治疗失败中的一小部分。