Implant-associated infections are rare, but a disaster for patients and physician. Only a subset of patients can be cured without removal of the implant. Current guidelines recommend to use a two-stage replacement of the implant in cases of MRSA.
Vancomycin is primarily bacteriostatic, and only at higher concentration bactericidal against MRSA. Own experiements in the nineties in-vitro as in an animal model clearly show that very high levels of vancomycin are necessary to kill adherent bacteria with vancomycin. These levels are very much above the toxic levels and therefore, vancomycin is ineffective against MRSA implant infections.
New drugs such as Daptomycin or ceftobiprole are more effective, but clinical trials are lacking. Daptomycin has been shown to kill adherent staphylococci.
However, the only drug currently available that rapidly kill adherent staphylococci is rifampin. Unfortunately, only a subset of MRSA implant infections is rifampin susceptible. These cases frequently require a two stage replacement of the device for cure.
We have collected the largest database on patients with implant infections over 20 years that were treated without removal of the device. Unfortunately, our MRSA policy was very effective, and only MRSA was isolated from only 2/835 cases. Therefore, the majority of cases were published by Mayo clinic in Rochester and from D.Raoult in Marseille, France.
However, treatment of MRSA implant infections is still a challenge, while methicillin-susceptible S.aureus respond in >90% to quinolone/rifampin combinations.