By: Danielle Casaus
Dr. Shah is an Infectious Diseases Clinical Pharmacy Specialist at Penn Medicine Lancaster General Hospital. He completed his PGY-1 pharmacy residency at Wellstar Atlanta Medical Center followed by his PGY-2 pharmacy residency in infectious disease at the University of Florida Health Shands Hospital. His research interests include antimicrobial stewardship, Gram-negative resistance, and diagnostic stewardship.
Dr. Shah and colleagues recently explored the benefit of adjunctive rifampin (RIF) to standard of care (non-RIF) therapy for prosthetic joint infections (PJIs) caused by staphylococcal species. The study focused on patients who received either a Debridement, Antibiotics, and Implant Retention (DAIR) or 1-stage exchange surgical intervention with roughly 60-80% of study patients undergoing a DAIR. Results showed that patients who received RIF had a statistically significant lower rate of treatment failure highlighting the benefit of adjunctive RIF in treating PJIs caused by staphylococcal species following a DAIR.
Research Q&A:
What sparked your interest in conducting research in this area?
The current data is mixed on whether adjunctive RIF provides a benefit for patients who receive a DAIR or 1-stage exchange surgical intervention for PJIs.
Did you feel like the results of your study could change practice?
My research showed that patients who received RIF had a statistically significant lower rate of treatment failure, which highlights the benefit of adjunctive RIF in treating PJIs caused by staphylococcal species following a DAIR. However, it is important to note the results of our study cannot be generalized much due to the small sample size (n=34). However, I do lean towards the side of the rifampin debate. I think our study could be used to emphasize using rifampin in the right patient.
What do you think future research should address to help us better understand rifampin’s role in therapy?
I think future research pertaining to rifampin needs to focus on the dosing. The current dosing seems to be extrapolated from tuberculosis dosing, which does not mean that staphylococcal species need to be dosed the same way. I would purpose the rifampin dosing study focus on therapeutic drug monitoring (TDM) to find the sweet spot in our dosing/concentrations to identify a more patient-specific regimen.
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