Rifabutin Versus Rifampicin for Treatment of Staphylococcal PJI Treated With DAIR

Inclusion Criteria:

1. Hip or knee Prosthetic joint infection treated by debridement, antibiotic therapyinitiation and retention of prothesis (DAIR strategy)
2. Infected with at least one of the following microorganisms:
3. Staphylococcus aureus
4. Coagulase-negative staphylococci
5. Microorganisms susceptible to rifampicin and at least one other antibiotic suitablefor the treatment of PJI (e.g., penicillin, fluoroquinolone, (doxy/mino)cycline,oxazolidinone, cotrimoxazole, daptomycin, glycopeptide, macrolide, fusidic acid),regardless of sensitivity to methicillin.
6. Age ≥ 18 years
7. At least 2 days of appropriate (i.e., covering pathogen(s) identified in theintraoperative samples) empirical agents are needed. Pre-randomization antimicrobialtherapy 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.
8. Signed Inform consent
9. Patient having the rights to French social insurance
10. For women of childbearing potential i.e. fertile, following menarche and untilbecoming post-menopausal unless permanently sterile and excludingoestroprogestative-based contraception, any effective contraceptive: vasectomy (formen), intrauterine device copper, feminine sterilization, condom, sexual abstinence isrequired. A postmenopausal state is defined as no menses for 12 months without analternative medical cause

Exclusion Criteria:

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