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Starnes V, Duggan J, Hollingshead C. Fungal Prosthetic Joint Infection: A Case Series and Review of the Literature. Infect Dis Ther 2024; 13:1051-1065. [PMID: 38613628 PMCID: PMC11098995 DOI: 10.1007/s40121-024-00964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Fungal prosthetic joint infections comprise less than 1% of prosthetic joint infections. Thus, little is known regarding optimal management. This study aims to characterize the microbiology, surgical and medical management, and outcomes for these complex infections. The objectives of this study were to assess the impact of surgical approach, antifungal treatment, fungal species, and time to onset of infection from initial surgery on patient outcomes. METHODS A retrospective record review over 12 years was performed in two health systems that included patients with a deep culture positive for a fungal isolate and the presence of a prosthetic joint. A literature review was performed using the same inclusion criteria. A total of 289 cases were identified and analyzed. RESULTS Candida was the most common isolate, and a two-stage revision was the most commonly employed surgical modality. The type of surgical intervention had a statistically significant relationship with outcome (P = 0.022). CONCLUSIONS Two-stage revision with extended antifungal therapy is preferred in these infections due to higher rates of positive outcomes.
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Affiliation(s)
- Victoria Starnes
- The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Joan Duggan
- Division of Infectious Diseases, The University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Caitlyn Hollingshead
- Division of Infectious Diseases, The University of Toledo College of Medicine and Life Sciences, Toledo, USA.
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2
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Lora-Tamayo J, Mancheño-Losa M, Meléndez-Carmona MÁ, Hernández-Jiménez P, Benito N, Murillo O. Appropriate Duration of Antimicrobial Treatment for Prosthetic Joint Infections: A Narrative Review. Antibiotics (Basel) 2024; 13:293. [PMID: 38666969 PMCID: PMC11047716 DOI: 10.3390/antibiotics13040293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024] Open
Abstract
Prosthetic joint infections are considered difficult to treat they needing aggressive surgery and long antimicrobial treatments. However, the exact duration of these therapies has been established empirically. In the last years, several studies have explored the possibility of reducing the length of treatment in this setting, with conflicting results. In this narrative review, we critically appraise the published evidence, considering the different surgical approaches (implant retention [DAIR] and one-step and two-step exchange procedures) separately. In patients managed with DAIR, usually treated for at least 12 weeks, a large, randomized trial failed to show that 6 weeks were non-inferior. However, another randomized clinical trial supports the use of 8 weeks, as long as the surgical conditions are favorable and antibiotics with good antibiofilm activity can be administered. In patients managed with a two-step exchange procedure, usually treated during 6 weeks, a randomized clinical trial showed the efficacy of a 4-week course of antimicrobials. Also, the use of local antibiotics may allow the use of even shorter treatments. Finally, in the case of one-step exchange procedures, there is a trend towards reducing the length of therapy, and the largest randomized clinical trial supports the use of 6 weeks of therapy.
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Affiliation(s)
- Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, 28041 Madrid, Spain; (M.M.-L.); (P.H.-J.)
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
- CIBERINFEC—CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mikel Mancheño-Losa
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, 28041 Madrid, Spain; (M.M.-L.); (P.H.-J.)
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
| | - María Ángeles Meléndez-Carmona
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Pilar Hernández-Jiménez
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, 28041 Madrid, Spain; (M.M.-L.); (P.H.-J.)
| | - Natividad Benito
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
- CIBERINFEC—CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- UQ Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane 4072, Australia
| | - Oscar Murillo
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
- CIBERINFEC—CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Bellvitge, IDIBELL (Instituto de Investigación Biomédica de Bellvitge), 08908 L’Hospitalet de Llobregat, Spain
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Herndon CL, Rowe TM, Metcalf RW, Odum SM, Fehring TK, Springer BD, Otero JE. Treatment Outcomes of Fungal Periprosthetic Joint Infection. J Arthroplasty 2023; 38:2436-2440.e1. [PMID: 37179024 DOI: 10.1016/j.arth.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) continues to challenge surgeons and patients. The burden of fungal organisms may represent approximately 1% of all PJI. Additionally, fungal PJI is difficult to treat. Most available case series are small and report poor success rates. Fungi are opportunistic pathogens and patients who have fungal PJI are believed to be immunocompromised. Additionally, fungal biofilms are more complex than those formed by other pathogens and confer additional drug resistance. Due to these factors, treatment failure is common. METHODS A retrospective review of our institutional registry was performed to identify patients treated for fungal PJI. There were 49 patients identified with 8 excluded for not having follow-up, which left 22 knees and 19 hips for analyses. Demographics, clinical characteristics, and surgical details were collected. The primary outcome was failure defined as reoperation for infection following the index surgery for fungal PJI within 1 year of the index surgery. RESULTS Failure occurred in 10 of 19 knees and 11 of the 22 hips. A higher proportion of patients who have extremity grade C failed treatment, and every patient who failed was host grade 2 or 3. The average number of prior surgeries and time from resection to reimplantation were similar between groups. CONCLUSION To our knowledge, this represents the largest cohort of fungal PJIs reported in the literature to date. This data supports other literature in that failure rates were high. More study is needed to further understand this entity and improve care for these patients.
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Affiliation(s)
- Carl L Herndon
- Columbia University Irving Medical Center, New York, New York
| | - Taylor M Rowe
- OrthoCarolina Research Institute, Charlotte, North Carolina
| | - Rory W Metcalf
- OrthoCarolina Research Institute, Charlotte, North Carolina
| | - Susan M Odum
- Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina
| | - Thomas K Fehring
- Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina; OrthoCarolina - Hip & Knee Center, Charlotte, North Carolina
| | - Bryan D Springer
- Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina; OrthoCarolina - Hip & Knee Center, Charlotte, North Carolina
| | - Jesse E Otero
- Atrium Health - Musculoskeletal Institute, Charlotte, North Carolina; OrthoCarolina - Hip & Knee Center, Charlotte, North Carolina
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Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms 2022; 11:microorganisms11010084. [PMID: 36677376 PMCID: PMC9864285 DOI: 10.3390/microorganisms11010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Fungal prosthetic joint infection (fPJI) is a rare complication; nonetheless, it represents a significant diagnostic and therapeutic challenge. There are no official guidelines on the most effective approach to identify and treat fPJIs. This systematic review aims to review the current literature on fPJI management and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Studies eligible for this systematic review were identified through an electronic systematic search of PubMed, Scopus, and Web of Science until 30 September 2022. Further references were obtained by cross-referencing. Sixty-three studies met the inclusion criteria, reporting on 372 cases of fPJI; such cases were described mostly in case reports and small case series with only a few larger cohort studies. Diagnosis of fPJI is challenging because of its chronic and indolent clinical course; it is further complicated by the technical difficulty of harvesting fungal cultures. A two-stage revision was the primary procedure in 239 (64.2%) patients whereas DAIR and one-stage approaches were reported in 30 (8.0%) and 18 (4.8 %) cases. In conclusion, our study highlights the heterogeneity of the reported treatments of fPJI, particularly in terms of medical management. With concern to a surgical approach, a two-stage revision arthroplasty is generally suggested, considering fPJI a delayed or late infection. The need for multicenter, prospective studies to provide standardized protocols and improve the treatment of fungal PJI clearly emerges.
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Sarzaeem MM, Beigi AN, Darestani RT, Omrani FA, Baroutkoub M, Rasi AM. Candida albicans Prosthetic Joint Infection After Total Knee Arthroplasty: A Rare Case Report. Adv Biomed Res 2022; 11:111. [PMID: 36798917 PMCID: PMC9926025 DOI: 10.4103/abr.abr_302_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 12/28/2022] Open
Abstract
In this article, a 75-year-old patient with pain in left knee and restricted range of motion following total knee arthroplasty (TKA) is presented. Serological evaluation and aspiration of knee joint suggested a fungal prosthetic joint infection. After the diagnosis was confirmed, treatment started with antifungal drugs, removing prosthesis, exhaustive debridement, and revision of TKA after efficient antifungal treatment. At one-year follow-up, she has a painless motion range of 10 to 90 degrees, and there was no recurrence of infection observed.
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Affiliation(s)
- Mohammad Mahdi Sarzaeem
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Norouz Beigi
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Tavakoli Darestani
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Amuzadeh Omrani
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Manafi Rasi
- Department of Orthopedic, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Alireza Manafi Rasi, 7th Floor, Bldg No. 2 SBUMS, Arabi Ave, Daneshjoo Blvd, Velenjak -19839-63113, Tehran, Iran. E-mail:
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Gamaletsou MN, Rammaert B, Brause B, Bueno MA, Dadwal SS, Henry MW, Katragkou A, Kontoyiannis DP, McCarthy MW, Miller AO, Moriyama B, Pana ZD, Petraitiene R, Petraitis V, Roilides E, Sarkis JP, Simitsopoulou M, Sipsas NV, Taj-Aldeen SJ, Zeller V, Lortholary O, Walsh TJ. Osteoarticular Mycoses. Clin Microbiol Rev 2022; 35:e0008619. [PMID: 36448782 PMCID: PMC9769674 DOI: 10.1128/cmr.00086-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Osteoarticular mycoses are chronic debilitating infections that require extended courses of antifungal therapy and may warrant expert surgical intervention. As there has been no comprehensive review of these diseases, the International Consortium for Osteoarticular Mycoses prepared a definitive treatise for this important class of infections. Among the etiologies of osteoarticular mycoses are Candida spp., Aspergillus spp., Mucorales, dematiaceous fungi, non-Aspergillus hyaline molds, and endemic mycoses, including those caused by Histoplasma capsulatum, Blastomyces dermatitidis, and Coccidioides species. This review analyzes the history, epidemiology, pathogenesis, clinical manifestations, diagnostic approaches, inflammatory biomarkers, diagnostic imaging modalities, treatments, and outcomes of osteomyelitis and septic arthritis caused by these organisms. Candida osteomyelitis and Candida arthritis are associated with greater events of hematogenous dissemination than those of most other osteoarticular mycoses. Traumatic inoculation is more commonly associated with osteoarticular mycoses caused by Aspergillus and non-Aspergillus molds. Synovial fluid cultures are highly sensitive in the detection of Candida and Aspergillus arthritis. Relapsed infection, particularly in Candida arthritis, may develop in relation to an inadequate duration of therapy. Overall mortality reflects survival from disseminated infection and underlying host factors.
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Affiliation(s)
- Maria N. Gamaletsou
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Blandine Rammaert
- Université de Poitiers, Faculté de médecine, CHU de Poitiers, INSERM U1070, Poitiers, France
| | - Barry Brause
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Marimelle A. Bueno
- Far Eastern University-Dr. Nicanor Reyes Medical Foundation, Manilla, Philippines
| | | | - Michael W. Henry
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aspasia Katragkou
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University School of Medicine, Columbus, Ohio, USA
| | | | - Matthew W. McCarthy
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
| | - Andy O. Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Zoi Dorothea Pana
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, New York, New York, USA
| | | | - Emmanuel Roilides
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | | | - Maria Simitsopoulou
- Hippokration General Hospital, Aristotle University School of Health Sciences, Thessaloniki, Greece
- Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece
| | - Nikolaos V. Sipsas
- Laiko General Hospital of Athens and Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Valérie Zeller
- Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Lortholary
- Université de Paris, Faculté de Médecine, APHP, Hôpital Necker-Enfants Malades, Paris, France
- Institut Pasteur, Unité de Mycologie Moléculaire, CNRS UMR 2000, Paris, France
| | - Thomas J. Walsh
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
- Weill Cornell Medicine of Cornell University, New York, New York, USA
- New York Presbyterian Hospital, New York, New York, USA
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
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7
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Zhang C, Lin Y, Huang C, Huang Z, Fang X, Bai G, Zhang Z, Li W, Zhang W. Metagenomic next-generation sequencing assists the diagnosis treatment of fungal osteoarticular infections. Front Cell Infect Microbiol 2022; 12:1072539. [PMID: 36506031 PMCID: PMC9726756 DOI: 10.3389/fcimb.2022.1072539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background Fungal osteoarticular infection (FOI) is not commonly seen in clinical practice but proposes a great challenge to orthopedic surgeons. In this study, we aimed to investigate the risk factors, the clinical features, and surgical outcomes of FOI in our institution. Specifically, we aimed to explore the role of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of FOI. Methods All the patients who were diagnosed and managed with FOI in our institution from January 2007 to December 2020 were retrospectively reviewed, including primary fungal implant-related infection, primary fungal osteomyelitis or arthritis, and fungal infections secondary to bacterial osteomyelitis or implant-related bacterial infections. The potential risk factors and the clinical and surgical features were analyzed. The pathogen data were compared between culture and the mNGS test. Results A total of 25 patients were included, namely, 12 primary implant-related infections, 7 primary fungal osteomyelitis or arthritis, and 6 fungal infections secondary to bacterial osteomyelitis or implant-related bacterial infections. Most cases had undergone multiple surgeries or long-term antibiotic treatment. Diagnosis was mainly based on microbial culture and the mNGS test. Optimization of culture methods and the use of mNGS assisted the diagnosis. Specifically, mNGS was performed in 12 patients, 5 of whom were culture-negative. In the remaining seven cases, mNGS demonstrated the same results as culture. Management of FOI was complicated as most patients required multiple surgeries followed by long-term antifungal treatment. In selected cases, antifungal-impregnated cement spacer retention can be an optional choice. The overall success rate was 100% (25/25) for our cohort. Conclusion We concluded that patients with comorbidities and a history of multiple surgeries or long-term antibiotics are under higher risk for FOI. Use of mNGS assists the diagnosis and treatment of FOI. Surgery combined with long-term antifungal treatment achieved satisfactory outcomes. In selected cases, antifungal-impregnated cement spacer retention can be an optional treatment choice.
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Affiliation(s)
- Chaofan Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yunzhi Lin
- Department of Stomatology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Stomatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Changyu Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zida Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xinyu Fang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guochang Bai
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zeyu Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wenbo Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wenming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedic Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Fujian Provincial Institute of Orthopedics, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China,*Correspondence: Wenming Zhang,
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Chisari E, Lin F, Fei J, Parvizi J. Fungal periprosthetic joint infection: Rare but challenging problem. Chin J Traumatol 2022; 25:63-66. [PMID: 35031203 PMCID: PMC9039431 DOI: 10.1016/j.cjtee.2021.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 02/04/2023] Open
Abstract
Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcusaureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%-2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.
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Affiliation(s)
- Emanuele Chisari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Feitai Lin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Jun Fei
- Department of Emergency Medicine of Army Medical Center, Army Medical University, Chongqing, 400042, China,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA,Corresponding author.
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Chong YC, Tse TST. A case of candida parapsilosis periprosthetic joint infection: Case report and literature review. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221075826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 76 year old female, with a background history of eczema and iatrogenic Cushing syndrome, received a right total knee replacement for her knee osteoarthritis. In the early post-operative period, a small amount of discharge was noted from the surgical wound. The wound swab culture of the discharge yielded candida species. It was regarded as contamination initially. Half year later, she presented with a subcutaneous abscess around the right knee. Aspiration and culture confirmed infection of Candida parapsilosis. The patient was treated conservatively with fluconazole because she had initially refused operative treatment. The infection progressed to abscess formation afterward. A two-stage revision arthroplasty with cement spacer was performed subsequently. In addition, we have reviewed the literature regarding fungal periprosthetic joint infection.
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Affiliation(s)
- Yau Chun Chong
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Tao Sun Tycus Tse
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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10
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Candida periprosthetic infection of the knee: a systematic review of surgical treatments and clinical outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:899-907. [PMID: 35182240 DOI: 10.1007/s00590-022-03224-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Candida periprosthetic joint infections (PJIs) are a rare cause of prosthesis revision with severe consequences and challenging treatment. This study aims to produce a systematic analysis of types of treatment and outcome of knee Candida PJIs and their correlation with specific pathogen species. METHODS During April 2021, a literature search was performed according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used the Oxford Level of Evidence (LoE) and Methodological index for non-randomized studies (MINORS) score. Modal value of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcome was calculated through Chi-square or Fisher exact test. RESULTS In total, 115 cases were collected through 51 articles, identifying 116 pathogens. Candida albicans was the most frequent pathogen. Analysis of LoE reveals 40 LoE 5 and 11 LoE 4. Thirteen patients underwent one-stage revision, 46 patients two-stage revision, 6 patients resection arthroplasty and arthrodesis, 4 patients long-term antifungal therapy, and 3 patients debridement with prosthesis retention. Global rate of success was 85.14%. Modal distribution revealed a preference for two-stage revision and Fluconazole in medical therapy. No difference in terms of fungal eradication was found among Candida species (p = 0.503) and for treatments except for two-stage revision and resection arthroplasty (p = 0.0125) or debridement with implant retention (p = 0.0498), and the rest of procedures and resection arthroplasty (0.0192). MINORS score was poor. CONCLUSIONS Analysis of the literature did not highlight any difference between types of surgical treatment and pathogens in terms of relapse or infection eradication. However, two-stage replacement may be preferred, allowing healing of infection in most cases.
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De Meo D, Cera G, Ceccarelli G, Castagna V, Aronica R, Pieracci EM, Persiani P, Villani C. Candida fracture-related infection: a systematic review. J Bone Jt Infect 2021; 6:321-328. [PMID: 34458074 PMCID: PMC8386193 DOI: 10.5194/jbji-6-321-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/28/2021] [Indexed: 11/11/2022] Open
Abstract
Background: The aim of this study is to summarize and improve knowledge regarding a Candida fracture-related infection (CFRI) through a systematic review on the topic, accompanied by a case report. Methods: A systematic review and meta-analysis based on PRISMA statement were conducted on the CFRI topic. The following combined search terms were used to explore PubMed, Cochrane, and the Embase database: "fungal infection", "candida", "fracture related infection", "bone infection", "orthopedic infection", "internal fixation", "post-traumatic infection", and "osteomyelitis". Results: Out of 1514 records, only 5 case reports matched the selection criteria and were included. Moreover, a new case of CFRI, not previously described, was reported in this paper and reviewed. The main risk factors for CFRI were open wounds (three cases) and immunodeficiency (three cases). Initial improvement of clinical and laboratory signs of infection was noted in all cases. In the available short-term follow-up (mean 12.1 months; range 3-42), the reoperation rate was 33.3 %. Using a strategy based on extensive debridement/resection methods and prolonged systemic antifungal therapy (mean 8.8 weeks; range 6-18), four of six cases (66.6 %) were cured. Bone union occurred in three out of six cases. Conclusion: There is very low-quality evidence available regarding CFRI. Candida infections in surgically treated fractures are rare but difficult-to-treat events, with a slow onset, unspecific symptoms or signs, and a significant relapse risk; therefore, they still represent a current diagnostic challenge. The existing fracture-related infection treatment algorithm combined with long-term systemic antifungal therapy has an anecdotal value and needs more extensive studies to be validated.
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Affiliation(s)
- Daniele De Meo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy.,M.I.T.O. Study Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I University Hospital, Viale del Policlinico, 155,00161 Rome, Italy
| | - Gianluca Cera
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy
| | - Giancarlo Ceccarelli
- M.I.T.O. Study Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I University Hospital, Viale del Policlinico, 155,00161 Rome, Italy.,Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy
| | - Valerio Castagna
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy
| | - Raissa Aronica
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy
| | - Edoardo M Pieracci
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy
| | - Pietro Persiani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy
| | - Ciro Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedic Science, Sapienza University of Rome, Piazzale A. Moro 5, 00155, Rome, Italy.,M.I.T.O. Study Group (Infectious Diseases in Traumatology and Orthopedics Surgery), Policlinico Umberto I University Hospital, Viale del Policlinico, 155,00161 Rome, Italy
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12
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Morimoto Y, Yo H, Ohashi H. Two-stage revision using antifungal-loaded cement beads for the treatment of Candida infection following revision total hip arthroplasty: A case report. J Orthop Sci 2021; 26:505-509. [PMID: 30293918 DOI: 10.1016/j.jos.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/04/2018] [Accepted: 09/01/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Yukiko Morimoto
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan
| | - Hirotake Yo
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan
| | - Hirotsugu Ohashi
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan.
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13
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Mu G, Liu H, Chen M, Liu X, Ou C. Ozone Treatment Unveils the Veil of Candida parapsilosis Infection in the Knee Joint: A Case Report and Literature Review. Mycopathologia 2020; 185:545-554. [PMID: 32318935 DOI: 10.1007/s11046-020-00447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/08/2020] [Indexed: 10/20/2022]
Abstract
Candida infection is common, while Candida parapsilosis infection in the knee joint is rare. Local symptoms of Candida infections in the knee are atypical, rarely associated with systemic symptoms, and difficult to distinguish from other types of knee arthritis. We here report a special case of C. parapsilosis infections in the knee joint. A patient had previously undergone knee puncture in a private clinic for the treatment of osteoarthritis and developed a left knee joint infection with C. parapsilosis. However, the patient only showed more severe local knee symptoms, and there was no systemic manifestation associated with any Candida infection. Surprisingly, after receiving ozone lavage, the patient showed symptoms of a systemic infection such as fever and chills. There was no positive finding in the blood cultures. Finally, the synovial fluid cultures showed a C. parapsilosis infections. After antifungal treatment and another knee ozone therapy, the patient did not experience recurrence of the infections. It is suggested that in this special case, the strong sterilization with ozone caused the destruction of C. parapsilosis, leading to a transient systemic toxin reaction. In addition, we reviewed the 17 cases of C. parapsilosis infections that have been reported thus far.
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Affiliation(s)
- Guo Mu
- Pain Department, Affiliated Hospital of Southwest Medical University, No. 25 Pacific Street, Luzhou, 646000, China
| | - Hongmei Liu
- Pain Department, Affiliated Hospital of Southwest Medical University, No. 25 Pacific Street, Luzhou, 646000, China
| | - Milian Chen
- Pain Department, Affiliated Hospital of Southwest Medical University, No. 25 Pacific Street, Luzhou, 646000, China
| | - Xiangbo Liu
- Pain Department, Affiliated Hospital of Southwest Medical University, No. 25 Pacific Street, Luzhou, 646000, China
| | - Cehua Ou
- Pain Department, Affiliated Hospital of Southwest Medical University, No. 25 Pacific Street, Luzhou, 646000, China.
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14
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Saconi ES, de Carvalho VC, de Oliveira PRD, Lima ALLM. Prosthetic joint infection due to Candida species: Case series and review of literature. Medicine (Baltimore) 2020; 99:e19735. [PMID: 32282732 PMCID: PMC7220503 DOI: 10.1097/md.0000000000019735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 01/07/2020] [Accepted: 03/04/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES After the initial management, 73% of the patients achieved clinical remission. CONCLUSION The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS Prosthetic joint infection, Candida, treatment, and diagnosis.
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15
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Depypere M, Kuehl R, Metsemakers WJ, Senneville E, McNally MA, Obremskey WT, Zimmerli W, Atkins BL, Trampuz A. Recommendations for Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus From an International Expert Group. J Orthop Trauma 2020; 34:30-41. [PMID: 31567902 PMCID: PMC6903362 DOI: 10.1097/bot.0000000000001626] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Abstract
Fracture-related infection (FRI) is a major complication in musculoskeletal trauma and one of the leading causes of morbidity. Standardization of general treatment strategies for FRI has been poor. One of the reasons is the heterogeneity in this patient population, including various anatomical locations, multiple fracture patterns, different degrees of soft-tissue injury, and different patient conditions. This variability makes treatment complex and hard to standardize. As these infections are biofilm-related, surgery remains the cornerstone of treatment, and this entails multiple key aspects (eg, fracture fixation, tissue sampling, debridement, and soft-tissue management). Another important aspect, which is sometimes less familiar to the orthopaedic trauma surgeon, is systemic antimicrobial therapy. The aim of this article is to summarize the available evidence and provide recommendations for systemic antimicrobial therapy with respect to FRI, based on the most recent literature combined with expert opinion. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Richard Kuehl
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | | | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, University of Lille, Lille, France
| | - Martin A. McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - William T. Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Werner Zimmerli
- Kantonsspital Baselland, Interdisciplinary Unit for Orthopedic Infections, Liestal, Switzerland; and
| | - Bridget L. Atkins
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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16
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Bini Viotti J, Corzo-Pedroza M, Gonzales Zamora JA. Prosthetic joint infection caused by Candida lusitaniae: report of a unique case. Acta Clin Belg 2019; 74:286-291. [PMID: 30136635 DOI: 10.1080/17843286.2018.1511264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Candida prosthetic joint infection (PJI) is a rare complication of total knee arthroplasty (TKA). The literature regarding its diagnosis and management is scarce. Case summary: We present the case of a 79-year-old woman with history of TKA and femoral intramedullary nailing, who developed PJI caused by Candida lusitaniae. A two-stage exchange arthroplasty was performed. She underwent implant removal, debridement and placement of temporary antibiotic impregnated spacer. Postoperatively, the patient received treatment with micafungin for 24 weeks. Eleven months after the first stage, the spacer was removed and a new knee prosthesis was placed. Complete eradication of infection was demonstrated by negative culture of cement spacer, synovial fluid and periprosthetic tissue. Histology of surgical samples was unremarkable. Empiric treatment with micafungin was given for 6 weeks after placement of the new prosthesis. At 6-month follow-up, there was no evidence of recurrent infection. Conclusion: To our knowledge, this is the first reported case of Candida lusitaniae PJI.
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Affiliation(s)
- Julia Bini Viotti
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Monica Corzo-Pedroza
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jose Armando Gonzales Zamora
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
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17
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Fang H, Huang L, Zhang R, Xie D, Sun H, Zeng C, Cai D. Recurrent arthritis caused by Candida parapsilosis: a case report and literature review. BMC Infect Dis 2019; 19:631. [PMID: 31315565 PMCID: PMC6637515 DOI: 10.1186/s12879-019-4255-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Candida arthritis is extremely rare and also represents a major challenge of diagnosis and treatment. Here we reported a rare case of recurrent arthritis caused by Candida parapsilosis. CASE PRESENTATION A 56-year-old Chinese male suffered from recurrent pain and swelling in his right knee after several times of "small needle-knife" acupuncture and corticosteroid injection of the joint. Candida parapsilosis was cultured in his synovial fluid and identified by sequencing of its Internal Transcribed Spacer (ITS) gene. Here we present the radiological characteristics, arthroscopic pictures, and synovium pathology of this patient. Also, blood test and chemical analysis of his synovial fluid were listed as well as the ITS sequence of this Candida species identified. The patient underwent thorough arthroscopic debridement and then set on fluconazole 400 mg daily for 12 months. His symptoms resolved and no relapse was observed on the last follow-up. Additionally, a brief but comprehensive review of C. parapsilosis arthritis episodes from past to now were studied. CONCLUSION With the detailed clinical information reported in this case and our literature review, we hope they would add to our knowledge of C. parapsilosis arthritis - its clinical settings, laboratory features, radiological characteristics, arthroscopic findings and experience of management.
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Affiliation(s)
- Hang Fang
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Academy of Orthopaedics, Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Orthopaedic Hospital of Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China
| | - Lisi Huang
- Department of Clinical Laboratory, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yanjiang West Road, Guangzhou, 510120, People's Republic of China
| | - Rongkai Zhang
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Academy of Orthopaedics, Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Orthopaedic Hospital of Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China
| | - Denghui Xie
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Academy of Orthopaedics, Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Orthopaedic Hospital of Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China
| | - Hengbiao Sun
- Department of Clinical Laboratory, The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China
| | - Chun Zeng
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Academy of Orthopaedics, Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.,Orthopaedic Hospital of Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China
| | - Daozhang Cai
- Department of Orthopaedics, The Third Affiliated Hospital of Southern Medical University, Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China. .,Academy of Orthopaedics, Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China. .,Orthopaedic Hospital of Guangdong Province, 183 Zhongshan Ave. West, Guangzhou, 510630, People's Republic of China.
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18
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Koutserimpas C, Zervakis SG, Maraki S, Alpantaki K, Ioannidis A, Kofteridis DP, Samonis G. Non- albicans Candida prosthetic joint infections: A systematic review of treatment. World J Clin Cases 2019; 7:1430-1443. [PMID: 31363471 PMCID: PMC6656666 DOI: 10.12998/wjcc.v7.i12.1430] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/16/2019] [Accepted: 04/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far.
AIM To clarify treatment of non-albicans Candida PJIs.
METHODS A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up.
RESULTS A total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases; 54.2%), followed by C. glabrata (18 cases; 21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59; 71%), followed by amphotericin B (41; 49.4%).
CONCLUSION The combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Athens 11525, Greece
| | - Stylianos G Zervakis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Heraklion 71110, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Heraklion 71110, Greece
| | - Kalliopi Alpantaki
- Department of Materials Science and Technology, University of Crete, Heraklion, Heraklion 71110, Greece
| | - Argyrios Ioannidis
- Department of General Surgery, “Sismanoglion” General Hospital of Athens, Athens 15126, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Heraklion 71110, Greece
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Crete, Heraklion 71110, Greece
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19
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Sidhu MS, Cooper G, Jenkins N, Jeys L, Parry M, Stevenson JD. Prosthetic fungal infections: poor prognosis with bacterial co-infection. Bone Joint J 2019; 101-B:582-588. [PMID: 31039037 DOI: 10.1302/0301-620x.101b5.bjj-2018-1202.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to report the efficacy of revision surgery for patients with co-infective bacterial and fungal prosthetic joint infections (PJIs) presenting to a single institution, and to identify prognostic factors that would guide management. PATIENTS AND METHODS A total of 1189 patients with a PJI were managed in our bone infection service between 2006 and 2015; 22 (1.85%) with co-infective bacterial and fungal PJI were included in the study. There were nine women and 13 men, with a mean age at the time of diagnosis of 64.5 years (47 to 83). Their mean BMI was 30.9 kg/m2 (24 to 42). We retrospectively reviewed the outcomes of these PJIs, after eight total hip arthroplasties and 14 total knee arthroplasties. The mean clinical follow-up was 4.1 years (1.4 to 8.8). RESULTS The median number of risk factors for PJI was 5.5 (interquartile range (IQR) 3.25 to 7.25). All seven patients who initially underwent debridement and implant retention (DAIR) had a recurrent infection that led to a staged revision. All 22 patients underwent the first of a two-stage revision. None of the nine patients with negative tissue cultures at the second stage had a recurrent infection. The rate of recurrent infection was significantly higher in the presence of multidrug-resistant bacteria (p = 0.007), a higher C-reactive protein (CRP) at the time of presentation (p = 0.032), and a higher number of co-infective bacterial organisms (p = 0.041). The overall rate of eradication of infection after two and five years was 50% (95% confidence interval (CI) 32.9 to 75.9) and 38.9% (95% CI 22.6 to 67), respectively. CONCLUSION The risk of failure to eradicate infection with the requirement of amputation associated with this diagnosis is much higher than in patients with PJI without bacterial and fungal co-infection, and this risk is heightened when the fungal organism is joined by polymicrobial and multidrug-resistant bacterial organisms. Cite this article: Bone Joint J 2019;101-B:582-588.
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Affiliation(s)
- M S Sidhu
- Bone Infection Service, Royal Orthopaedic Hospital, Birmingham, UK
| | - G Cooper
- Bone Infection Service, Royal Orthopaedic Hospital, Birmingham, UK
| | - N Jenkins
- Bone Infection Service, Royal Orthopaedic Hospital, Birmingham, UK.,Department of Infection and Tropical Medicine, University Hospitals Birmingham, Birmingham, UK
| | - L Jeys
- Bone Infection Service, Royal Orthopaedic Hospital, Birmingham, UK.,School of Life and Health Sciences, Aston University, Birmingham, UK
| | - M Parry
- Bone Infection Service, Royal Orthopaedic Hospital, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
| | - J D Stevenson
- Bone Infection Service, Royal Orthopaedic Hospital, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
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20
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Belden K, Cao L, Chen J, Deng T, Fu J, Guan H, Jia C, Kong X, Kuo FC, Li R, Repetto I, Riccio G, Tarabichi M. Hip and Knee Section, Fungal Periprosthetic Joint Infection, Diagnosis and Treatment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S387-S391. [PMID: 30343967 DOI: 10.1016/j.arth.2018.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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21
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Gao Z, Li X, Du Y, Peng Y, Wu W, Zhou Y. Success Rate of Fungal Peri-Prosthetic Joint Infection Treated by 2-Stage Revision and Potential Risk Factors of Treatment Failure: A Retrospective Study. Med Sci Monit 2018; 24:5549-5557. [PMID: 30093606 PMCID: PMC6098671 DOI: 10.12659/msm.909168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to investigate the success rate of fungal peri-prosthetic joint infection treated by 2-stage revision and related factors of treatment failure to offer a better treatment protocol. Material/Methods We reviewed 18 joints (13 knees and 5 hips) of 17 patients (10 women and 7 men) diagnosed with fungal peri-prosthetic joint infection from January 2000 to June 2015 at our institute. The mean follow-up was 65.1 months (range, 25–129 months). All joints were treated with complete debridement, implantation of antifungal-loaded cement spacers, at least 6 weeks of parenteral antifungal agents, and delayed reimplantation. Results Notably, 15 joints were infected with Candida, and molds were isolated in 3 joints. The median duration of resection arthroplasty and reimplantation was 33.9 weeks (range, 12–132 weeks). Thirteen (10 knees and 3 hips, 72.2%) of the 18 joints (13 knees and 5 hips) had no recurrent or persistent infection, while the remaining 5 joints (3 knees and 2 hips, 27.8%) failed to control infection after reimplantation of prosthesis or spacer. The long interval between prosthesis resection and reimplantation (69 weeks vs. 23.1 weeks, p=0.240) and mixed bacterial infection (80% vs. 46.2%, p=0.314) were associated with higher failure rate. Conclusions Debridement with the retention of the prosthesis is not an ideal treatment protocol for fungal peri-prosthetic joint infection; thus, a two-stage revision could be valid. We suggest that 6 weeks of parenteral antifungal agents are necessary, and 6 subsequent weeks of oral antifungal treatment is also important. We do not recommend that the two-stage revision be performed on patients who have more than 2 host risk factors.
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Affiliation(s)
- Zhisen Gao
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Xiang Li
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Yinqiao Du
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Yawen Peng
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Wenming Wu
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
| | - Yonggang Zhou
- Department of Orthopedics, The General Hospital of Chinese People's Liberation Army, Beijing, China (mainland)
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22
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Brown TS, Petis SM, Osmon DR, Mabry TM, Berry DJ, Hanssen AD, Abdel MP. Periprosthetic Joint Infection With Fungal Pathogens. J Arthroplasty 2018; 33:2605-2612. [PMID: 29636249 DOI: 10.1016/j.arth.2018.03.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/05/2018] [Accepted: 03/02/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although there is abundant information about bacterial periprosthetic joint infections (PJIs), there is a notable paucity of information about fungal PJIs. The goals of this study are to describe the patient demographics, diagnostic findings, and treatment results of fungal PJIs after total joint arthroplasty. METHODS We identified 31 fungal PJIs (13 total hip arthroplasties and 18 total knee arthroplasties) in 31 patients treated between 1996 and 2014. This represented 0.9% of the 3525 PJIs treated at our institution during this time period. Candida species accounted for 81% of infections. The mean patient age at diagnosis of fungal PJI was 68 years. Mean follow-up after initiation of treatment was 4 years. RESULTS In the total hip arthroplasty cohort, survivorship free from all-cause revision or implant removal was 44% at 2 years. Survivorship free from reinfection was 38% at 2 years. Mean Harris hip score was 27 at final follow-up.In the total knee arthroplasty cohort, survivorship free from all-cause revision was 70% at 2 years. Survivorship free from reinfection was 76% at 2 years. Mean Knee Society scores were 36 at final follow-up. CONCLUSION Fungal PJIs are rare (0.9% of diagnosed PJIs). Survivorship free of all-cause revision or implant removal was very low in the hip group (44% at 2 years), but slightly better in the knee group (70% at 2 years). Moreover, clinical outcomes were poor with high perioperative complication rates. Improved treatment regimens are needed for this unsolved clinical problem.
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Affiliation(s)
- Timothy S Brown
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Stephen M Petis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Douglas R Osmon
- Department of Internal Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Tad M Mabry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arlen D Hanssen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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23
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Escolà-Vergé L, Rodríguez-Pardo D, Lora-Tamayo J, Morata L, Murillo O, Vilchez H, Sorli L, Carrión LG, Barbero JM, Palomino-Nicás J, Bahamonde A, Jover-Sáenz A, Benito N, Escudero R, Sampedro MF, Vidal RP, Gómez L, Corona PS, Almirante B, Ariza J, Pigrau C. Candida periprosthetic joint infection: A rare and difficult-to-treat infection. J Infect 2018; 77:151-157. [PMID: 29746950 DOI: 10.1016/j.jinf.2018.03.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies. METHODS We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 in 16 Spanish hospitals. RESULTS Forty-three patients included: median age, 75 years, and median Charlson Comorbidity Index score, 4. Thirty-four (79.1%) patients had ≥1 risk factor for Candida infection. Most common causative species were C. albicans and C. parapsilosis. Thirty-five patients were evaluable for outcome: overall, treatment succeeded in 17 (48.6%) and failed in 18 (51.4%). Success was 13/20 (67%) in patients with prosthesis removal and 4/15 (27%) with debridement and prosthesis retention (p = 0.041). All 3 patients who received an amphotericin B-impregnated cement spacer cured. In the prosthesis removal group, success was 5/6 (83%) with an antibiofilm regimen and 8/13 (62%) with azoles (p = 0.605). In the debridement and prosthesis retention group, success was 3/10 (30%) with azoles and 1/5 (20%) with antibiofilm agents. Therapeutic failure was due to relapse in 9 patients, need for suppressive treatment in 5, persistent infection in 2, and CPJI-related death in 2; overall attributable mortality was 6%. CONCLUSIONS CPJI is usually a chronic disease in patients with comorbidities and risk factors for Candida infection. Treatment success is low, and prosthesis removal improves outcome. Although there is insufficient evidence that use of antifungals with antibiofilm activity has additional benefits, our experience indicates it may be recommendable.
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Affiliation(s)
- Laura Escolà-Vergé
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaime Lora-Tamayo
- Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre "i+12", Madrid, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Helem Vilchez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Palma, Spain
| | - Luisa Sorli
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR) Institut Hospital del Mar d'Investigacioms Mèdiques (IMIM) CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | | | - José Mª Barbero
- Internal Medicine Department, Hospital Príncipe de Asturias, Universidad de Alcalá de Henares, Madrid
| | - Julián Palomino-Nicás
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | | | - Alfredo Jover-Sáenz
- Infectious Diseases Department, Unidad Territorial para el control de la Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Escudero
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS
| | - Marta Fernandez Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, Cantabria, Spain
| | - Rafael Pérez Vidal
- Infectious Diseases Unit, Internal Medicine Department, Althaia, Hospital de Sant Joan de Déu, Manresa, Spain
| | - Lucía Gómez
- Internal Medicine, Hospital Universitari Mútua de Terrassa, Barcelona, Spain
| | - Pablo S Corona
- Reconstructive and Septic Surgery Division, Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain
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24
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Xiang Y, Xuan YY, Li G. Successful treatment for acute prosthetic joint infection due to MRSA and Candida albicans: a case report and literature review. Ther Clin Risk Manag 2018; 14:1133-1139. [PMID: 29950850 PMCID: PMC6016578 DOI: 10.2147/tcrm.s165247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) and Candidal prosthetic joint infections (PJIs) are very rare, and the optimal management for these patients is still unknown. A 54-year-old man with traumatic arthritis due to previous electric injury successfully retained the implant despite the successive infection with MRSA and Candida albicans after total knee arthroplasty (TKA). Continuous lavage with vancomycin was used to control MRSA infection and repeated local washout plus oral swallow with voriconazole tablet were administered to eradicate C. albicans. Additional three reported cases were identified by the criteria of selecting patients with concomitant and/or successive MRSA and Candidal PJIs. Different methods were applied with variable outcomes. Therefore, several risk factors such as intra-articular corticosteroid injection, high frequency of door openings in the operating room, excessive blood loss and allogeneic red blood cell transfusions should be avoided. Debridement, antibiotics and implant retention (DAIR) can be an alternative in dedicated patients to control acute MRSA and Candidal PJIs. Particularly, repeated intra-articular washout with susceptible drugs and a prolonged duration of oral antibiotics was essential for microbial control.
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Affiliation(s)
- Yong Xiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yi-Yi Xuan
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Guangheng Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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25
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Giles C, Lamont-Friedrich SJ, Michl TD, Griesser HJ, Coad BR. The importance of fungal pathogens and antifungal coatings in medical device infections. Biotechnol Adv 2017; 36:264-280. [PMID: 29199134 DOI: 10.1016/j.biotechadv.2017.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/15/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022]
Abstract
In recent years, increasing evidence has been collated on the contributions of fungal species, particularly Candida, to medical device infections. Fungal species can form biofilms by themselves or by participating in polymicrobial biofilms with bacteria. Thus, there is a clear need for effective preventative measures, such as thin coatings that can be applied onto medical devices to stop the attachment, proliferation, and formation of device-associated biofilms. However, fungi being eukaryotes, the challenge is greater than for bacterial infections because antifungal agents are often toxic towards eukaryotic host cells. Whilst there is extensive literature on antibacterial coatings, a far lesser body of literature exists on surfaces or coatings that prevent attachment and biofilm formation on medical devices by fungal pathogens. Here we review strategies for the design and fabrication of medical devices with antifungal surfaces. We also survey the microbiology literature on fundamental mechanisms by which fungi attach and spread on natural and synthetic surfaces. Research in this field requires close collaboration between biomaterials scientists, microbiologists and clinicians; we consider progress in the molecular understanding of fungal recognition of, and attachment to, suitable surfaces, and of ensuing metabolic changes, to be essential for designing rational approaches towards effective antifungal coatings, rather than empirical trial of coatings.
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Affiliation(s)
- Carla Giles
- Future Industries Institute, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, Adelaide, SA 5000, Australia
| | - Stephanie J Lamont-Friedrich
- Future Industries Institute, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, Adelaide, SA 5000, Australia
| | - Thomas D Michl
- Future Industries Institute, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, Adelaide, SA 5000, Australia
| | - Hans J Griesser
- Future Industries Institute, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, Adelaide, SA 5000, Australia
| | - Bryan R Coad
- Future Industries Institute, University of South Australia, Mawson Lakes Blvd, Mawson Lakes, Adelaide, SA 5000, Australia; School of Agriculture Food & Wine, The University of Adelaide, Waite Campus, Adelaide, SA 5000, Australia.
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26
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Single-Stage Revision for Chronic Fungal Periprosthetic Joint Infection: An Average of 5 Years of Follow-Up. J Arthroplasty 2017; 32:2523-2530. [PMID: 28478188 DOI: 10.1016/j.arth.2017.03.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Periprosthetic infections caused by fungal pathogens are a rare entity, and there exist no definite guidelines according to which these infections can be successfully managed. In these situations, we wondered whether patients could be treated successfully for their fungal infections with single-stage revision. METHODS A retrospective analysis between January 2004 and October 2014 included 11 patients (4 hips and 7 knees) with chronic fungal periprosthetic joint infection who underwent single-stage revision, including aggressive soft-tissue debridement, thorough removal of infected components and cement, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungus-sensitive antibiotics, and a reasonable combination of antifungal agents and antibacterial medications. Recurrence of infection and clinical outcomes were evaluated. The average follow-up was 5 years (range, 2-10 years). RESULTS There were 3 failures during the study period; 1 patient died during the perioperative period because of acute heart failure on the eighth postoperative day. Of the 11 patients, 7 patients had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The mean postoperative Harris hip score and Hospital for Special Surgery knee score was 77 points (67-88 points; P < .05) and 78 points (73-84 points; P < .05), respectively, at the most recent assessment. CONCLUSION Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes, which indicated that this may be a feasible alternative strategy in selected patients.
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27
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Cobo F, Rodríguez-Granger J, Sampedro A, Aliaga-Martínez L, Navarro-Marí JM. Candida Prosthetic Joint Infection. A Review of Treatment Methods. J Bone Jt Infect 2017; 2:114-121. [PMID: 28540147 PMCID: PMC5441142 DOI: 10.7150/jbji.17699] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.
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Affiliation(s)
- Fernando Cobo
- Department of Microbiology, Hospital Virgen de las Nieves, Granada, Spain
| | | | - Antonio Sampedro
- Department of Microbiology, Hospital Virgen de las Nieves, Granada, Spain
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28
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Cobo F, Rodríguez-Granger J, López EM, Jiménez G, Sampedro A, Aliaga-Martínez L, Navarro-Marí JM. Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report. Infect Dis (Lond) 2016; 49:81-94. [DOI: 10.1080/23744235.2016.1219456] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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29
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Gamaletsou MN, Rammaert B, Bueno MA, Sipsas NV, Moriyama B, Kontoyiannis DP, Roilides E, Zeller V, Taj-Aldeen SJ, Miller AO, Petraitiene R, Lortholary O, Walsh TJ. Candida Arthritis: Analysis of 112 Pediatric and Adult Cases. Open Forum Infect Dis 2015; 3:ofv207. [PMID: 26858961 PMCID: PMC4742637 DOI: 10.1093/ofid/ofv207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/23/2015] [Indexed: 12/11/2022] Open
Abstract
Background. Candida arthritis is a debilitating form of deeply invasive candidiasis. However, its epidemiology, clinical manifestations, management, and outcome are not well understood. Methods. Cases of Candida arthritis were reviewed from 1967 through 2014. Variables included Candida spp in joint and/or adjacent bone, underlying conditions, clinical manifestations, inflammatory biomarkers, diagnostic imaging, management, and outcome. Results. Among 112 evaluable cases, 62% were males and 36% were pediatric. Median age was 40 years (range, <1–84 years). Most patients (65%) were not pharmacologically immunosuppressed. Polyarticular infection (≥3 joints) occurred in 31% of cases. Clinical manifestations included pain (82%), edema (71%), limited function (39%), and erythema (22%) with knees (75%) and hips (15%) most commonly infected. Median erythrocyte sedimentation rate was 62 mm/hr (10–141) and C reactive protein 26 mg/dL (0.5–95). Synovial fluid median white blood cell count was 27 500/µL (range, 100–220 000/µL) with 90% polymorphonuclear neutrophils (range, 24–98). Adjacent osteomyelitis was present in 30% of cases. Candida albicans constituted 63%, Candida tropicalis 14%, and Candida parapsilosis 11%. Most cases (66%) arose de novo, whereas 34% emerged during antifungal therapy. Osteolysis occurred in 42%, joint-effusion in 31%, and soft tissue extension in 21%. Amphotericin and fluconazole were the most commonly used agents. Surgical interventions included debridement in 25%, irrigation 10%, and drainage 12%. Complete or partial response was achieved in 96% and relapse in 16%. Conclusion. Candida arthritis mainly emerges as a de novo infection in usually non-immunosuppressed patients with hips and knees being most commonly infected. Localizing symptoms are frequent, and the most common etiologic agents are C albicans, C tropicalis, and C parapsilosis. Management of Candida arthritis remains challenging with a clear risk of relapse, despite antifungal therapy.
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Affiliation(s)
- Maria N Gamaletsou
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology, New York, New York; National and Kapodistrian and University of Athens, Greece; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York
| | - Blandine Rammaert
- Université Paris-Descartes, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine; Unité de Mycologie Moléculaire, Institut Pasteur, Paris, France
| | - Marimelle A Bueno
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology , New York, New York
| | - Nikolaos V Sipsas
- National and Kapodistrian and University of Athens, Greece; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York
| | - Brad Moriyama
- Department of Pharmacy , National Institutes of Health Clinical Center , Bethesda, Maryland
| | | | - Emmanuel Roilides
- Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; 3rd Department of Pediatrics, Aristotle University School of Health Sciences and Hippokration General Hospital, Thessaloniki, Greece
| | - Valerie Zeller
- Osteoarticular Reference Center , Groupe Hospitalier Diaconesses-Croix Saint-Simon , Paris , France
| | | | - Andy O Miller
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology, New York, New York; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; Hospital for Special Surgery, New York, New York
| | - Ruta Petraitiene
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology , New York, New York
| | - Olivier Lortholary
- Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; Université Paris-Descartes, Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine
| | - Thomas J Walsh
- Weill Cornell Medicine of Cornell University, Departments of Medicine, Pediatrics, and Microbiology & Immunology, New York, New York; Center for Osteoarticular Mycoses, Hospital for Special Surgery, New York, New York; Hospital for Special Surgery, New York, New York
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30
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Schoof B, Jakobs O, Schmidl S, Klatte TO, Frommelt L, Gehrke T, Gebauer M. Fungal periprosthetic joint infection of the hip: a systematic review. Orthop Rev (Pavia) 2015; 7:5748. [PMID: 25874063 PMCID: PMC4387364 DOI: 10.4081/or.2015.5748] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 02/16/2015] [Indexed: 11/23/2022] Open
Abstract
Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty with an incidence of approximately 1%. Due to the high risk of persisting infection, successful treatment of fungal PJI is challenging. The purpose of this study was to gain insight into the current management of fungal PJI of the hip and, by systematically reviewing the cases published so far, to further improve the medical treatment of this serious complication of total hip arthroplasty. Thus, we conducted a systematic review of the available literature concerning fungal PJI in total hip arthroplasty, including 45 cases of fungal PJI. At the moment a two-stage revision procedure is favorable and there is an ongoing discussion on the therapeutic effect of antifungal drug loaded cement spacers on fungal periprosthetic infections of the hip. Due to the fact that there is rare experience with it, there is urgent need to establish guidelines for the treatment of fungal infections of total hip arthroplasty.
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Affiliation(s)
- Benjamin Schoof
- Department of Orthopedic Surgery, HELIOS Endo-Clinic Hamburg , Hamburg, Germany
| | - Oliver Jakobs
- Department of Orthopedic Surgery, HELIOS Endo-Clinic Hamburg , Hamburg, Germany
| | - Stefan Schmidl
- Department of Orthopedic Surgery, HELIOS Endo-Clinic Hamburg , Hamburg, Germany
| | - Till Orla Klatte
- Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Lars Frommelt
- Centre of Infections and Microbiology, HELIOS Endo-Clinic , Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, HELIOS Endo-Clinic Hamburg , Hamburg, Germany
| | - Matthias Gebauer
- Department of Orthopedic Surgery, HELIOS Endo-Clinic Hamburg , Hamburg, Germany
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31
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Jakobs O, Schoof B, Klatte TO, Schmidl S, Fensky F, Guenther D, Frommelt L, Gehrke T, Gebauer M. Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review. Orthop Rev (Pavia) 2015; 7:5623. [PMID: 25874061 PMCID: PMC4387362 DOI: 10.4081/or.2015.5623] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/07/2014] [Indexed: 12/30/2022] Open
Abstract
Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.
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Affiliation(s)
- Oliver Jakobs
- Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany
| | - Benjamin Schoof
- Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany
| | - Till Orla Klatte
- Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Stefan Schmidl
- Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany
| | - Florian Fensky
- Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Daniel Guenther
- Department of Trauma, Hannover Medical School , Hamburg, Germany
| | - Lars Frommelt
- Institute for Clinical Microbiology, Infectiology and Infection Control, Helios Endo-Klinik Hamburg , Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany
| | - Matthias Gebauer
- Department of Orthopedic Surgery, Helios Endo-Klinik Hamburg , Hamburg, Germany ; Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
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32
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Zuo Q, Dong L, Mu W, Zhou L, Hu T, Zhang H. Trichosporon asahii infection after total knee arthroplasty: A case report and review of the literature. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2015; 26:47-51. [PMID: 25798156 PMCID: PMC4353271 DOI: 10.1155/2015/458670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reports of fungal infection after total knee arthroplasty are extremely rare. In most reports, the infecting organism is a Candida species. The present report describes a case involving a 73-year-old immunocompetent woman who underwent total knee arthroplasty and presented one month later with signs of prosthetic infection. She underwent joint debridement and the fluid was sent for culture and sensitivity testing. The culture showed growth of Trichosporon asahii. The patient was administered intravenous and intra-articular injections of amphotericin B, followed by antifungal treatment with voriconazole for one year. At 26 months of follow-up, there was no evidence of infection and the patient was ambulating with a walker. To the authors' knowledge, the present case is the first report of T asahii infection following knee replacement. Early detection, prompt institution of the appropriate antibiotics and regular follow-up are recommended.
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Affiliation(s)
- Qiang Zuo
- Department of Orthopedics, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province
- Department of Orthopedics, the First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia
| | - Lele Dong
- Department of Orthopedics, the First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia
| | - Weidong Mu
- Department of Orthopedics, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province
- Correspondence: Dr Weidong Mu, Department of Orthopedics, Provincial Hospital Affiliated to Shandong University, No. 324, Jingwu Road, Jinan 250021, Shandong Province, People’s Republic of China. Telephone 86-151-6886-3989, fax 86-180-4721-1365, e-mail
| | - Lingyun Zhou
- International Education College, Jiang Xi University of Traditional Chinese Medicine, Nanchang, Jiangxi Province
| | - Tongping Hu
- Clinical Laboratory, the First Affiliated Hospital of Baotou Medical College
| | - Hua Zhang
- Department of Oncology, the Third Affiliated Hospital of Inner Mongolia Medical College, Baotou, Inner Mongolia, People’s Republic of China
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Deep Infection With Candida albicans Following Total Hip Replacement. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a1eeae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current concepts in the management of periprosthetic fungal joint infection using antifungal bone cement. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gebauer M, Frommelt L, Achan P, Board TN, Conway J, Griffin W, Heidari N, Kerr G, McLaren A, Nelson SB, Nijhof M, Zahar A. Management of fungal or atypical periprosthetic joint infections. J Arthroplasty 2014; 29:112-4. [PMID: 24360494 DOI: 10.1016/j.arth.2013.09.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Gebauer M, Frommelt L, Achan P, Board TN, Conway J, Griffin W, Heidari N, Kerr G, McLaren A, Nelson SB, Nijhof M, Zahar A. Management of fungal or atypical periprosthetic joint infections. J Orthop Res 2014; 32 Suppl 1:S147-51. [PMID: 24464889 DOI: 10.1002/jor.22559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Kuiper JWP, van den Bekerom MPJ, van der Stappen J, Nolte PA, Colen S. 2-stage revision recommended for treatment of fungal hip and knee prosthetic joint infections. Acta Orthop 2013; 84:517-23. [PMID: 24171675 PMCID: PMC3851663 DOI: 10.3109/17453674.2013.859422] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Fungal prosthetic joint infections are rare and difficult to treat. This systematic review was conducted to determine outcome and to give treatment recommendations. PATIENTS AND METHODS After an extensive search of the literature, 164 patients treated for fungal hip or knee prosthetic joint infection (PJI) were reviewed. This included 8 patients from our own institutions. RESULTS Most patients presented with pain (78%) and swelling (65%). In 68% of the patients, 1 or more risk factors for fungal PJI were found. In 51% of the patients, radiographs showed signs of loosening of the arthroplasty. Candida species were cultured from most patients (88%). In 21% of all patients, fungal culture results were first considered to be contamination. There was co-infection with bacteria in 33% of the patients. For outcome analysis, 119 patients had an adequate follow-up of at least 2 years. Staged revision was the treatment performed most often, with the highest success rate (85%). INTERPRETATION Fungal PJI resembles chronic bacterial PJI. For diagnosis, multiple samples and prolonged culturing are essential. Fungal species should be considered to be pathogens. Co-infection with bacteria should be treated with additional antibacterial agents. We found no evidence that 1-stage revision, debridement, antibiotics, irrigation, and retention (DAIR) or antifungal therapy without surgical treatment adequately controls fungal PJI. Thus, staged revision should be the standard treatment for fungal PJI. After resection of the prosthesis, we recommend systemic antifungal treatment for at least 6 weeks-and until there are no clinical signs of infection and blood infection markers have normalized. Then reimplantation can be performed.
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Affiliation(s)
- Jesse WP Kuiper
- Department of Orthopedic Surgery, Center for Orthopaedic Research Alkmaar (CORAL), Alkmaar Medical Center, Alkmaar; the Netherlands
| | | | | | - Peter A Nolte
- Department of Orthopedic Surgery, Spaarne Hospital, Hoofddorp, the Netherlands.
| | - Sascha Colen
- Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg Site, Belgium
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Ueng SWN, Lee CY, Hu CC, Hsieh PH, Chang Y. What is the success of treatment of hip and knee candidal periprosthetic joint infection? Clin Orthop Relat Res 2013; 471:3002-9. [PMID: 23633184 PMCID: PMC3734391 DOI: 10.1007/s11999-013-3007-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 04/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fungal infection at an arthroplasty site is rare and poses a therapeutic challenge. To the best of our knowledge, no reports have been published thus far on the success rate of prosthesis reimplantation after fungal prosthetic joint infections. QUESTIONS/PURPOSES We asked: (1) What is the success rate in terms of infection eradication using a two-stage exchange arthroplasty in patients with hip or knee fungal periprosthetic joint infections, particularly focusing on Candida infections? (2) What patient-, infection-, and treatment-related variables are associated with the success or failure of treatment? METHODS From January 2000 to December 2010, 16 patients with hip or knee candidal periprosthetic joint infections were treated with two-stage exchange arthroplasty at our institute. Treatment success was defined as a well-functioning joint without relapse of candidal infection after prosthesis reimplantation, while treatment failure was defined as uncontrolled or relapse of candidal infection or mortality. Variables, including age, sex, comorbidities, microbiology, antimicrobial agents used, and operative methods, were analyzed. Minimum followup was 28 months (mean, 41 months; range, 28-90 months). RESULTS At latest followup, the treatment failed to eradicate the infection in eight of the 16 patients, and there were four deaths related to fungemia. Four patients required permanent resection arthroplasty owing to uncontrolled or recurrent candidal infections. All eight patients (50% successful rate) who had their infections eradicated and successful prosthesis reimplantation had prolonged treatment with oral fluconazole before (mean, 8 months) and after (mean, 2.2 months) prosthesis reimplantation. The antifungal therapy correlated with successful treatment. Renal insufficiency, hypoalbuminemia, anemia, and chronic obstructive pulmonary disease were significantly more prevalent in the treatment-failure group than in the treatment-success group. CONCLUSIONS Half of the patients treated with two-stage exchange arthroplasty for fungal periprosthetic joint infections had recurrence or lack of control of the infection. A prolonged antifungal therapy appeared to be essential for successful treatment of candidal periprosthetic joint infections. The presence of renal insufficiency, hypoalbuminemia, anemia, or chronic obstructive pulmonary disease might be associated with a poor outcome.
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Affiliation(s)
- Steve W. N. Ueng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St, Kweishan, Linkou, 333 Taiwan ,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yu Lee
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-chien Hu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St, Kweishan, Linkou, 333 Taiwan ,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pang-Hsin Hsieh
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St, Kweishan, Linkou, 333 Taiwan ,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuhan Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin St, Kweishan, Linkou, 333 Taiwan ,School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Abstract
Fungal prosthetic joint infection after total knee arthroplasty (TKA) is a rare complication. Lacunae exist in the management of this complication. 62 year old lady presented with pain and swelling in left knee and was diagnosed as Candida tropicalis fungal infection after TKA. She underwent debridement, resection arthroplasty and antifungal plus antibiotic loaded cement spacer insertion, antifungal therapy with fluconazole followed by delayed revision TKA and further fluconazole therapy. Total duration of fluconazole therapy was 30 weeks. At 2 year followup, she has pain less range of motion of 10(°)-90(°) and there is no evidence of recurrence of infection.
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Affiliation(s)
- Kankanala J Reddy
- Department of Orthopedics and Trauma, Apollo Hospital, Jubilee Hills, Hyderabad, Andhra Pradesh, India,Address for correspondence: Dr. Kankanala J Reddy, Room No. 960, International Block, Apollo Hospital, Jubilee Hills, Hyderabad - 500 033, Andhra Pradesh, India. E-mail:
| | - Jay D Shah
- Department of Orthopedics and Trauma, Apollo Hospital, Jubilee Hills, Hyderabad, Andhra Pradesh, India
| | - Rohit V Kale
- Department of Orthopedics and Trauma, Apollo Hospital, Jubilee Hills, Hyderabad, Andhra Pradesh, India
| | - T Jayakrishna Reddy
- Department of Orthopedics and Trauma, Apollo Hospital, Jubilee Hills, Hyderabad, Andhra Pradesh, India
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40
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Candida albicans Infection of a Reverse-Polarity Shoulder Replacement in a Patient With Rheumatoid Arthritis Treated With Etanercept. J Clin Rheumatol 2012; 18:323. [DOI: 10.1097/rhu.0b013e3182685b83] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hwang BH, Yoon JY, Nam CH, Jung KA, Lee SC, Han CD, Moon SH. Fungal peri-prosthetic joint infection after primary total knee replacement. ACTA ACUST UNITED AC 2012; 94:656-9. [PMID: 22529086 DOI: 10.1302/0301-620x.94b5.28125] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We retrospectively reviewed 30 two-stage revision procedures in 28 patients performed for fungal peri-prosthetic joint infection (PJI) after a primary total knee replacement. Patients were followed for at least two years or until the infection recurred. The mean follow-up for patients who remained free of infection was 4.3 years (2.3 to 6.1). Overall, 17 patients were assessed as American Society of Anesthesiologists grade 3 or 4. The surgical protocol included removal of the infected implant, vigorous debridement and insertion of an articulating cement spacer. This was followed by at least six weeks of antimicrobial treatment and delayed reimplantation in all patients. The mean interval between removal of the prosthesis and reimplantation was 9.5 weeks (6 to 24). After reimplantation, patients took antifungal agents orally for a maximum of six months. Two knees became reinfected at one and two months post-operatively, respectively: one of these subsequently required arthrodesis because of uncontrolled infection. Fungal PJIs can be treated successfully by removal of all infected material, appropriate antimicrobial treatment and delayed reimplantation.
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Affiliation(s)
- B H Hwang
- Himchan Hospital, Joint & Arthritis Research, Department of Orthopaedic Surgery, 404-3 Mok-dong, Yangcheon-gu, Seoul 158-806, Korea
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42
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Orthopaedic device associated Candidal infection – A retrospective review of patient characteristics and outcome. J Infect 2011; 63:167-71. [DOI: 10.1016/j.jinf.2011.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 05/28/2011] [Indexed: 11/21/2022]
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Yilmaz M, Mete B, Ozaras R, Kaynak G, Tabak F, Tenekecioğlu Y, Oztürk R. Aspergillus fumigatus infection as a delayed manifestation of prosthetic knee arthroplasty and a review of the literature. ACTA ACUST UNITED AC 2011; 43:573-8. [PMID: 21526903 DOI: 10.3109/00365548.2011.574294] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fungal infection after total joint arthroplasty is a very rare but serious complication and a challenge to the treating and consulting physicians. The literature includes little information about the treatment protocol for Aspergillus infection after total knee arthroplasty, since only 3 cases have been reported. We describe the case of a non-immunocompromised patient who lacked predisposing risk factors and presented with pain and swelling. An aspiration under sterile conditions revealed Aspergillus fumigatus. The patient was treated successfully with a 2-stage exchange reimplantation and 6-week course of liposomal amphotericin B. At 4 y after reimplantation, the patient had no evidence of infection or pain.
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Affiliation(s)
- Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey.
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44
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Dutronc H, Dauchy FA, Cazanave C, Rougie C, Lafarie-Castet S, Couprie B, Fabre T, Dupon M. Candida prosthetic infections: case series and literature review. ACTA ACUST UNITED AC 2010; 42:890-5. [PMID: 20608769 DOI: 10.3109/00365548.2010.498023] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Candida prosthetic joint infections are considered to be rare. We retrospectively studied patients treated for Candida prosthetic infections between 1 January 1995 and 31 December 2007 in our infectious diseases department, a tertiary referral centre. We identified 7 patients, 4 with knee and 3 with hip prosthetic infections. The most frequent fungal agent was Candida albicans (4 cases), followed by Candida parapsilosis (2 cases) and Candida guillermondii (1 case). All the patients received antifungal treatment for a prolonged period. Five patients had their prosthesis removed and 3 had reimplantation, 1 patient was treated with debridement and prosthetic retention, and the last patient refused surgery. The mean follow-up time was 2.5 y. At the last evaluation, 3 patients were considered as cured, 3 patients presented a secondary bacterial infection leading to amputation for 2 of them, and 1 patient died from heart failure. During Candida prosthetic joint infections, the epidemiological characteristics and the location of the prosthesis are very similar to bacterial prosthetic infections. The benchmark antifungal therapies remain amphotericin B and/or fluconazole.
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Affiliation(s)
- Herve Dutronc
- Service de Maladies Infectieuses et Tropicales, Hôpital Pellegrin, Université Victor Segalen Bordeaux 2, CHU de Bordeaux, Bordeaux, France.
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van Asbeck EC, Clemons KV, Stevens DA. Candida parapsilosis: a review of its epidemiology, pathogenesis, clinical aspects, typing and antimicrobial susceptibility. Crit Rev Microbiol 2010; 35:283-309. [PMID: 19821642 DOI: 10.3109/10408410903213393] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Candida parapsilosis family has emerged as a major opportunistic and nosocomial pathogen. It causes multifaceted pathology in immuno-compromised and normal hosts, notably low birth weight neonates. Its emergence may relate to an ability to colonize the skin, proliferate in glucose-containing solutions, and adhere to plastic. When clusters appear, determination of genetic relatedness among strains and identification of a common source are important. Its virulence appears associated with a capacity to produce biofilm and production of phospholipase and aspartyl protease. Further investigations of the host-pathogen interactions are needed. This review summarizes basic science, clinical and experimental information about C. parapsilosis.
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Affiliation(s)
- Eveline C van Asbeck
- Division of Infectious Diseases, Santa Clara Valley Medical Center, and California Institute for Medical Research, San Jose, CA 95128, USA
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46
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Kelesidis T, Tsiodras S. Candida albicans prosthetic hip infection in elderly patients: is fluconazole monotherapy an option? SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2010; 42:12-21. [PMID: 20055725 PMCID: PMC8054237 DOI: 10.3109/00365540903253510] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The increasing numbers of joint arthroplasties being undertaken, and the increase in patients with systemic illnesses undergoing the procedure, have contributed to a continuing increase in prosthetic joint infections. Candida prosthetic joint infection is a rare clinical entity, and only 12 cases of Candida albicans prosthetic hip infection have been described. Although surgery combined with a long period of antifungal medication is the usual treatment for fungal prosthetic joint infections, monotherapy with antifungal agents has only very rarely been used as a therapeutic option, especially in debilitated and elderly patients. We report herein the second case, to our knowledge, of C. albicans prosthetic hip arthritis successfully treated with fluconazole monotherapy and review the literature on the pathogenesis, clinical manifestations and management of these infections. Further studies on the use of fluconazole in the management of fungal prosthetic infections are needed.
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Affiliation(s)
- Theodoros Kelesidis
- Department of Medicine, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, 736 Cambridge Street, Boston, MA 02135, USA.
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Azzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T, Springer B, Bozic K, Della Valle C, Pulido L, Barrack R. Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg Am 2009; 91 Suppl 6:142-9. [PMID: 19884422 DOI: 10.2106/jbjs.i.00574] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Khalid Azzam
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, PA 19107, USA
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Abstract
SUMMARY Candida parapsilosis is an emerging major human pathogen that has dramatically increased in significance and prevalence over the past 2 decades, such that C. parapsilosis is now one of the leading causes of invasive candidal disease. Individuals at the highest risk for severe infection include neonates and patients in intensive care units. C. parapsilosis infections are especially associated with hyperalimentation solutions, prosthetic devices, and indwelling catheters, as well as the nosocomial spread of disease through the hands of health care workers. Factors involved in disease pathogenesis include the secretion of hydrolytic enzymes, adhesion to prosthetics, and biofilm formation. New molecular genetic tools are providing additional and much-needed information regarding C. parapsilosis virulence. The emerging information will provide a deeper understanding of C. parapsilosis pathogenesis and facilitate the development of new therapeutic approaches for treating C. parapsilosis infections.
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49
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Evaluation and Treatment of Candida Species in Prosthetic Joint Infections. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2008. [DOI: 10.1097/ipc.0b013e31817cfdb7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. Antibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee Arthroplasty. J Bone Joint Surg Am 2007. [DOI: 10.2106/00004623-200704000-00026] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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