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Prosthetic Joint Infection — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionProsthetic Joint InfectionSCE Infectious Diseases

A 68-year-old man with a prosthetic hip replacement for 4 years presents with 6 weeks of progressive pain and stiffness. Inflammatory markers are mildly elevated (CRP 35 mg/L). A bone scan shows increased uptake around the prosthesis. Joint aspiration grows Staphylococcus epidermidis (methicillin-sensitive) from enrichment cultures. What is the most important antibiotic to include in the long-term suppressive regimen?

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Correct answer: D — Rifampicin

In chronic prosthetic joint infection with staphylococci, Rifampicin is the key anti-biofilm agent. It penetrates biofilm on prosthetic material and kills sessile bacteria that other antibiotics cannot reach. It should never be used as monotherapy due to rapid resistance emergence. The standard approach for DAIR (debridement, antibiotics, and implant retention) includes a backbone antibiotic (e.g. Flucloxacillin or a fluoroquinolone) plus Rifampicin. If the prosthesis is retained, Rifampicin-containing regimens are associated with significantly better outcomes.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections