Table 3.

Patients with treatment failure and subsequent management

Patient	Organism(s) isolated	Initial medical managementa				Receiving antibiotic therapy at time of failure	Criterion for treatment failureb	Microbiological failure	Rifampin resistance detected	Management of treatment failure	Outcome of retreatment	Time of follow-up after treatment failure (mo)
		Parenteral antibiotic(s)	Duration of parenteral antibiotic(s) (days)	Oral antibiotic(s)	Duration of oral antibiotic(s) (mo)
1	MRSA plus Escherichia coli	V, CTX	52	R, FA	17	Yes	3	No	No	Above-knee amputation	Free from subsequent failure	19
2	MR-CNS (2 different isolates)	V	7	R, FA	1	Yes	1	Yes	Yes	Two-stage exchange	Free from subsequent failure	42
3	MRSA plus Escherichia coli	V, M	59	R, FA, C	7	Yes	1	Yes	No	Life-long suppression with rifampin and fusidic acidc	Life-long antibiotic suppression	30
4	MRSA	V	7	R, FA	6	Yes	2	No	Yesd	Further debridement followed by clindamycin and amoxicillin for 24 mo	Developed sinus tract	24
5	MRSA	V	14	R, FA	1	Yes	4	No	No	Debridement and rifampin and fusidic acid for 22 mo	Free from subsequent failure	24
6	MRSA	V	2	R, FA	4	Yes	1	Yes	Yes	Two-stage exchange	Free from subsequent failure	68
7	MRSA	V	12	R, FA	1	Yes	2	No	No	Debridement and 6 mo ciprofloxacin	Free from subsequent failure	74
8	MRSA	V	15	R, FA	1	Yes	1	Yes	Yes	Resection arthroplasty	Free from subsequent failure	4
9	MRSA plus Enterococcus faecalis	V	3	R	2e	No	4	No	No	Recommenced rifampin and fusidic acid for 15 mo	Free from subsequent failure	36

^aV, vancomycin; CTX, ceftriaxone; M, meropenem; R, rifampin; FA, fusidic acid; A, amoxicillin; C, ciprofloxacin.

^bCriteria for treatment failure were as follows: 1, recurrence of same microorganism(s); 2, isolation of a different microorganism(s); 3, periprosthetic purulence observed; 4, development of sinus tract.

^cThe patient presented with a new diagnosis of myasthenia gravis requiring prolonged intensive care unit admission and was too unwell for further surgical interventions.

^dMRSE (methicillin-resistant S. epidermidis) resistant to rifampin and fusidic acid was subsequently isolated from the patient.

^eAll oral antibiotics were ceased due to acute renal failure/acute interstitial nephritis.