Rifabutin Versus Rifampicin for Treatment of Staphylococcal PJI Treated With DAIR

Inclusion criteria

• Hip or knee Prosthetic joint infection treated by debridement, antibiotic therapy initiation and retention of prothesis (DAIR strategy)
• Infected with at least one of the following microorganisms:

• Staphylococcus aureus
• Coagulase-negative staphylococci
• Microorganisms susceptible to rifampicin and at least one other antibiotic suitable for the treatment of PJI (e.g., penicillin, fluoroquinolone, (doxy/mino)cycline, oxazolidinone, cotrimoxazole, daptomycin, glycopeptide, macrolide, fusidic acid), regardless of sensitivity to methicillin.
• Age ≥ 18 years
• At least 2 days of appropriate (i.e., covering pathogen(s) identified in the intraoperative samples) empirical agents are needed. Pre-randomization antimicrobial therapy could be: flucloxacillin, oxacillin, vancomycin, daptomycin. β-lactam plus β-lactamase-inhibitors (e.g. ampicillin+sulbactam, piperacillin+tazobactam), cephalosporins (except ceftazidime), carbapenems, teicoplanin, ceftaroline, ceftobiprole.
• Signed Inform consent
• Patient having the rights to French social insurance
• For women of childbearing potential i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile and excluding oestroprogestative-based contraception, any effective contraceptive: vasectomy (for men), intrauterine device copper, feminine sterilization, condom, sexual abstinence is required. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause

Exclusion criteria

• Suspicion of reduce absorption of oral treatment due to abdominal disorder Known or suspected malabsorption (imperfect absorption of food material by the small intestine)
• Polymicrobial infection due to other than staphylococcus species susceptible to rifampicin
• Known or suspected allergy to rifabutin and/or rifampicin
• Diagnosis of endocarditis associated to PJI
• Renal transplant or Chronic kidney disease with an eGFR of less than 30ml/min/1.73m²
• Other Solid Organ Transplant
• Liver cirrhosis, Child-Pugh score C
• Any other concomitant infection which required a prolonged course of intravenous antibiotic therapy
• Oestroprogestative-based contraception
• Oral anticoagulant drugs
• Other drug-drug interaction that contraindicated rifampicin or rifabutin
• Porphyria
• Unable to take oral treatment
• Receive empirical postoperative antibiotic treatment by rifampicin or rifabutin prior to randomization
• Pregnancy or lactating women
• Curator or guardianship or patient placed under judicial protection
• Participation in other interventional research during the study