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... Show moreThe 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 Staphylococcus aureus hip PJI, 54% for S aureus 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 metaanalysis indicates that rifampicin may only prevent a small fraction of all treatment failures. Show less
Leprosy is an infectious disease caused by Mycobacterium leprae. The global number of new leprosy patients has remained constant over the past decennium, indicating that transmission is ongoing.... Show moreLeprosy is an infectious disease caused by Mycobacterium leprae. The global number of new leprosy patients has remained constant over the past decennium, indicating that transmission is ongoing. People living in the same household as untreated leprosy cases have the highest risk of infection. Therefore, it is essential that leprosy control strategy is focused on this risk group. Immunoprophylaxis (vaccination) andchemoprophylaxis (medication) can be used to prevent the spread of leprosy among contacts of leprosy patients, each giving a protective effect of around 60%. In the COLEP trial, an additional additiveprotective effect of SDR (80%) in contacts that had received BCG vaccination in the past was found. To assess the efficacy of a combined strategy, the MALTALEP study was initiated, a cluster randomized controlled trial in the northwest of Bangladesh between 2012 and 2018, in which around 15,000 contacts ofnewly diagnosed leprosy patients received either BCG alone, or BCG plus SDR. The primary outcomewas the development of leprosy within two years. SDR reduced the number of new PB leprosy cases amongst contacts that had been vaccinated with BCG with 42% (non-significant). However, a large proportion of the new leprosy patients (33.6%) arose between vaccination and SDR. Show less
Keijzer, J. de; Mulder, A.; Beer, J. de; Ru, A.H. de; Veelen, P.A. van; Soolingen, D. van 2016
