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Dini C, Borges MHR, Malheiros SS, Piazza RD, van den Beucken JJJP, de Avila ED, Souza JGS, Barão VAR. Progress in Designing Therapeutic Antimicrobial Hydrogels Targeting Implant-associated Infections: Paving the Way for a Sustainable Platform Applied to Biomedical Devices. Adv Healthc Mater 2024:e2402926. [PMID: 39440583 DOI: 10.1002/adhm.202402926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/19/2024] [Indexed: 10/25/2024]
Abstract
Implantable biomedical devices have found widespread use in restoring lost functions or structures within the human body, but they face a significant challenge from microbial-related infections, which often lead to implant failure. In this context, antimicrobial hydrogels emerge as a promising strategy for treating implant-associated infections owing to their tunable physicochemical properties. However, the literature lacks a comprehensive analysis of antimicrobial hydrogels, encompassing their development, mechanisms, and effect on implant-associated infections, mainly in light of existing in vitro, in vivo, and clinical evidence. Thus, this review addresses the strategies employed by existing studies to tailor hydrogel properties to meet the specific needs of each application. Furthermore, this comprehensive review critically appraises the development of antimicrobial hydrogels, with a particular focus on solving infections related to metallic orthopedic or dental implants. Then, preclinical and clinical studies centering on providing quantitative microbiological results associated with the application of antimicrobial hydrogels are systematically summarized. Overall, antimicrobial hydrogels benefit from the tunable properties of polymers and hold promise as an effective strategy for the local treatment of implant-associated infections. However, future clinical investigations, grounded on robust evidence from in vitro and preclinical studies, are required to explore and validate new antimicrobial hydrogels for clinical use.
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Affiliation(s)
- Caroline Dini
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
| | - Maria Helena Rossy Borges
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
| | - Samuel Santana Malheiros
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
| | - Rodolfo Debone Piazza
- Physical Chemistry Department, Institute of Chemistry, São Paulo State University (UNESP), Araraquara, São Paulo, 14800-900, Brazil
| | | | - Erica Dorigatti de Avila
- Department of Dental Materials and Prosthodontics, School of Dentistry at Araçatuba, São Paulo State University (UNESP), Araçatuba, São Paulo, 16015-050, Brazil
| | - João Gabriel S Souza
- Dental Research Division, Guarulhos University (UNG), Guarulhos, São Paulo, 07023-070, Brazil
| | - Valentim A R Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, Universidade Estadual de Campinas (UNICAMP), Piracicaba, São Paulo, 13414-903, Brazil
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Dinh A, McNally M, D'Anglejan E, Mamona Kilu C, Lourtet J, Ho R, Scarborough M, Dudareva M, Jesuthasan G, Ronde Oustau C, Klein S, Escolà-Vergé L, Rodriguez Pardo D, Delobel P, Lora-Tamayo J, Mancheño-Losa M, Sorlí Redó ML, Barbero Allende JM, Arvieux C, Vaznaisiène D, Bauer T, Roux AL, Noussair L, Corvec S, Fernández-Sampedro M, Rossi N, Lemaignen A, Costa Salles MJ, Cunha Ribeiro T, Mazet J, Sasso M, Lavigne JP, Sotto A, Canouï E, Senneville É, Thill P, Lortholary O, Lanternier F, Morata L, Soriano A, Giordano G, Fourcade C, Franck BJH, Hofstätter JG, Duran C, Bonnet E. Prosthetic Joint Infections due to Candida Species: A Multicenter International Study. Clin Infect Dis 2024:ciae395. [PMID: 39189831 DOI: 10.1093/cid/ciae395] [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: 03/28/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI. METHODS This was a retrospective observational multinational study including patients diagnosed with Candida-related PJI between 2010 and 2021. Treatment outcome was assessed at 2-year follow-up. RESULTS A total of 269 patients were analyzed. Median age was 73.0 (interquartile range [IQR], 64.0-79.0) years; 46.5% of patients were male and 10.8% were immunosuppressed. Main infection sites were hip (53.0%) and knee (43.1%), and 33.8% patients had fistulas. Surgical procedures included debridement, antibiotics, and implant retention (DAIR) (35.7%), 1-stage exchange (28.3%), and 2-stage exchange (29.0%). Candida spp identified were Candida albicans (55.8%), Candida parapsilosis (29.4%), Candida glabrata (7.8%), and Candida tropicalis (5.6%). Coinfection with bacteria was found in 51.3% of cases. The primary antifungal agents prescribed were azoles (75.8%) and echinocandins (30.9%), administered for a median of 92.0 (IQR, 54.5-181.3) days. Cure was observed in 156 of 269 (58.0%) cases. Treatment failure was associated with age >70 years (OR, 1.811 [95% confidence interval {CI}: 1.079-3.072]), and the use of DAIR (OR, 1.946 [95% CI: 1.157-3.285]). Candida parapsilosis infection was associated with better outcome (OR, 0.546 [95% CI: .305-.958]). Cure rates were significantly different between DAIR versus 1-stage exchange (46.9% vs 67.1%, P = .008) and DAIR versus 2-stage exchange (46.9% vs 69.2%, P = .003), but there was no difference comparing 1- to 2-stage exchanges (P = .777). CONCLUSIONS Candida PJI prognosis seems poor, with high rate of failure, which does not appear to be linked to immunosuppression, use of azoles, or treatment duration.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Martin McNally
- Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Emma D'Anglejan
- Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Christel Mamona Kilu
- Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Julie Lourtet
- Clinical Microbiology Laboratory, Saint-Joseph Hospital, Paris
| | - Rosemary Ho
- Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Matthew Scarborough
- Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Maria Dudareva
- Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Gerald Jesuthasan
- Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Cecile Ronde Oustau
- Orthopedic Surgery Department, Strasbourg University Hospital, Strasbourg, France
| | - Stéphane Klein
- Orthopedic Surgery Department, Strasbourg University Hospital, Strasbourg, France
| | - Laura Escolà-Vergé
- Infectious Disease Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Pierre Delobel
- Infectious Disease Department, Toulouse University Hospital, Toulouse, France
| | - Jaime Lora-Tamayo
- Internal Medicine Department, Hospital Universitario 12 de Octubre, Madrid
| | | | | | - José María Barbero Allende
- Internal Medicine Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Cédric Arvieux
- Infectious Disease Department, Rennes University Hospital, Rennes, France
| | - Danguole Vaznaisiène
- Infectious Disease Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Anne-Laure Roux
- Microbiology Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches
| | - Latifa Noussair
- Microbiology Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches
| | - Stéphane Corvec
- Infectious Disease Department, Nantes University Hospital, Nantes, France
| | - Marta Fernández-Sampedro
- Internal Medicine Department, Marques de Valdecilla Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Centro De Investigación Biomédica En Red Enfermedades Infecciosas (CIBERINFEC), Santander, Spain
| | - Nicolò Rossi
- Orthopedic Surgery Department, Sant'Orsola Polyclinic, Bologna, Italy
| | - Adrien Lemaignen
- Infectious Disease Department, Bretonneau University Hospital, Tours, France
| | - Mauro José Costa Salles
- Infectious Disease Department, Faculdade de Ciências Médicas Santa Casa de São Paulo, São Paulo, Brazil
| | - Taiana Cunha Ribeiro
- Infectious Disease Department, Faculdade de Ciências Médicas Santa Casa de São Paulo, São Paulo, Brazil
| | - Julien Mazet
- Infectious Disease Department, Caremeau University Hospital, Nîmes
| | - Milène Sasso
- Infectious Disease Department, Caremeau University Hospital, Nîmes
| | | | - Albert Sotto
- Infectious Disease Department, Caremeau University Hospital, Nîmes
| | - Etienne Canouï
- Infectious Disease Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris
| | - Éric Senneville
- Infectious Disease Department, Lille University Hospital, Lille
| | - Pauline Thill
- Infectious Disease Department, Lille University Hospital, Lille
| | - Olivier Lortholary
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Mycology Department, Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris Cité University, Groupe de Recherche Translationnelle en Mycologie, Paris, France
| | - Fanny Lanternier
- Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Mycology Department, Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris Cité University, Groupe de Recherche Translationnelle en Mycologie, Paris, France
| | - Laura Morata
- Infectious Disease Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Disease Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gérard Giordano
- Orthopedic surgery department, Joseph Ducuing Hospital, Toulouse, France
| | - Camille Fourcade
- Infectious Disease Department, Joseph Ducuing Hospital, Toulouse, France
| | - Bernhard J H Franck
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna, Speising, Austria
| | - Jochen G Hofstätter
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna, Speising, Austria
| | - Clara Duran
- Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches, France
| | - Eric Bonnet
- Infectious Disease Department, Joseph Ducuing Hospital, Toulouse, France
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Doub JB, Siddiqui H. Propensity of Candida spp. prosthetic joint infection clinical isolates to form aggregates in synovial fluid and the clinical ramifications. Mycoses 2024; 67:e13769. [PMID: 39039764 DOI: 10.1111/myc.13769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Bacterial aggregation has been shown to occur in synovial fluid which are resistant to high concentrations of antibiotics. Yet the propensity of Candida spp. to form aggregates is unknown. OBJECTIVE To assess the ability of numerous Candida spp. to form synovial fluid aggregates and the clinical ramifications of the aggregates. METHODS Nine different Candidal prosthetic joint infection clinical isolates were evaluated for their ability to form aggregates at static and dynamic conditions and their resistance to high concentrations of amphotericin. Furthermore, the ability of tissue plasminogen activator (TPA) to disrupt the aggregates and enhance amphotericin activity was assessed. RESULTS The results show that all species of Candida spp. evaluated formed aggregates in synovial fluid under dynamic conditions that were resistant to amphotericin. Yet no aggregates formed in tryptic soy broth under any conditions or in synovial fluid under static conditions. As well, when TPA was combined with amphotericin there was a statistically significant decrease (p < .005) in the amount of colony forming units per mL for all Candidal species evaluated. Interestingly, for Candida krusei there was no colony forming units observed after exposure to TPA and amphotericin. CONCLUSION Our findings suggest that Candidal species form synovial fluid aggregates that are resistant to high dose amphotericin similar to those that occur with bacteria. However, the varying ability of the different Candida spp. to form hyphae and pseudohyphae compared to yeast cells may have direct impacts on the hardiness of the aggregates and thereby have clinical ramifications with respect to treatment durations.
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Affiliation(s)
- James B Doub
- The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Hamda Siddiqui
- The Doub Laboratory of Translational Bacterial Research, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Menotti F, Scutera S, Maniscalco E, Coppola B, Bondi A, Costa C, Longo F, Mandras N, Pagano C, Cavallo L, Banche G, Malandrino M, Palmero P, Allizond V. Is Silver Addition to Scaffolds Based on Polycaprolactone Blended with Calcium Phosphates Able to Inhibit Candida albicans and Candida auris Adhesion and Biofilm Formation? Int J Mol Sci 2024; 25:2784. [PMID: 38474027 DOI: 10.3390/ijms25052784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/14/2024] Open
Abstract
Candida spp. periprosthetic joint infections are rare but difficult-to-treat events, with a slow onset, unspecific symptoms or signs, and a significant relapse risk. Treatment with antifungals meets with little success, whereas prosthesis removal improves the outcome. In fact, Candida spp. adhere to orthopedic devices and grow forming biofilms that contribute to the persistence of this infection and relapse, and there is insufficient evidence that the use of antifungals has additional benefits for anti-biofilm activity. To date, studies on the direct antifungal activity of silver against Candida spp. are still scanty. Additionally, polycaprolactone (PCL), either pure or blended with calcium phosphate, could be a good candidate for the design of 3D scaffolds as engineered bone graft substitutes. Thus, the present research aimed to assess the antifungal and anti-biofilm activity of PCL-based constructs by the addition of antimicrobials, for instance, silver, against C. albicans and C. auris. The appearance of an inhibition halo around silver-functionalized PCL scaffolds for both C. albicans and C. auris was revealed, and a significant decrease in both adherent and planktonic yeasts further demonstrated the release of Ag+ from the 3D constructs. Due to the combined antifungal, osteoproliferative, and biodegradable properties, PCL-based 3D scaffolds enriched with silver showed good potential for bone tissue engineering and offer a promising strategy as an ideal anti-adhesive and anti-biofilm tool for the reduction in prosthetic joints of infections caused by Candida spp. by using antimicrobial molecule-targeted delivery.
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Affiliation(s)
- Francesca Menotti
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Sara Scutera
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Eleonora Maniscalco
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Bartolomeo Coppola
- Department of Applied Science and Technology, Politecnico di Torino, 10129 Turin, Italy
| | - Alessandro Bondi
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Cristina Costa
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Fabio Longo
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Narcisa Mandras
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Claudia Pagano
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Lorenza Cavallo
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Giuliana Banche
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
| | - Mery Malandrino
- Department of Chemistry, NIS Interdepartmental Centre, University of Torino, 10125 Turin, Italy
| | - Paola Palmero
- Department of Applied Science and Technology, Politecnico di Torino, 10129 Turin, Italy
| | - Valeria Allizond
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy
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Choe H, Maruo A, Hieda Y, Abe K, Kobayashi N, Ike H, Kumagai K, Takeyama M, Kawabata Y, Inaba Y. Novel Local Antifungal Treatment for Fungal Periprosthetic Joint Infection With Continuous Local Antibiotic Perfusion: A Surgical Technique. Arthroplast Today 2023; 24:101245. [PMID: 38023642 PMCID: PMC10665700 DOI: 10.1016/j.artd.2023.101245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/08/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Fungal periprosthetic joint infections are one of the most intractable orthopedic disorders. Continuous local antibiotic perfusion allows direct administration of the antifungal agent micafungin into the local infection area at biofilm-disruptive concentrations, while controlling the dead space in addition to conventional treatment. Although the appropriate use of continuous local antibiotic perfusion requires familiarity with the characteristics of local antibiotic perfusion, it is a versatile treatment modality that can improve the clinical outcomes of fungal periprosthetic joint infection in combination with conventional treatment methods.
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Affiliation(s)
- Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Akihiro Maruo
- Department of Orthopaedic Surgery, Harima Himeji General Medical Center, Himeji, Japan
| | - Yuta Hieda
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Masanobu Takeyama
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Yusuke Kawabata
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
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Li M, Fan M, Zhang Y, Xiao J, Liu T, Yu Q. Efficacy of DAIR in managing Candida parapsilosis-infected total knee arthroplasty with five-year follow-up: A case report and review of literature. Medicine (Baltimore) 2023; 102:e36246. [PMID: 38013258 PMCID: PMC10681585 DOI: 10.1097/md.0000000000036246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
RATIONALE Fungal periprosthetic joint infections (fPJIs) are relatively uncommon, accounting for approximately 1% of all PJIs. Revision surgery is typically recommended for fungal infections; however, the physical and financial impact on patients is significant. In this report, we present a case of fPJI successfully treated with debridement, antibiotics, and implant retention (DAIR) with a favorable outcome over a 5-year period. PATIENT CONCERN A 56-year-old male patient presented with a non-healing surgical incision 1 week after undergoing primary total knee arthroplasty on the right side. DIAGNOSIS Microbiological culture of the wound effusion identified Candida parapsilosis. Postoperatively, the patient exhibited a significant decrease in serum albumin levels and poor glycemic control. Both C-reactive protein and erythrocyte sedimentation rate were elevated. INTERVENTIONS A comprehensive DAIR procedure was performed, along with continuous closed irrigation using fluconazole for 1 week. The patient received intravenous voriconazole for 4 weeks, followed by oral fluconazole for an additional 3 months. OUTCOMES At 1- and 5-year follow-up appointments, the patient C-reactive protein and erythrocyte sedimentation rate levels were within normal limits, and there was no evidence of swelling, erythema, or tenderness in the right knee joint, indicating no signs of infection. LESSONS DAIR is an effective treatment for early fPJIs, and continuous closed irrigation may provide specific advantages. The patient nutritional status plays a crucial role in the management of periprosthetic infections.
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Affiliation(s)
- Menglong Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Mingrui Fan
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuchen Zhang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianlin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tong Liu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qingwei Yu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
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Orive Bañuelos A, Santamaría Carro A, Feijóo Lera R, Sacristán Egüén C, Andollo Victoriano N, Etxebarria Ecenarro J. Candida Colonization on the Surface of Contact Lenses in Long-Term Wearers and Boston Type 1 Keratoprosthesis Patients Presenting as White Mulberry-Shaped Deposits. Eye Contact Lens 2023; 49:188-192. [PMID: 37088944 DOI: 10.1097/icl.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To report Candida colonies on the surface of the contact lens in long-term contact lens wearers and patients with Boston type 1 keratoprosthesis (KPro I). METHODS A retrospective study was performed based on analyzing cultures from bandage contact lenses with small whitish mulberry-shaped deposits on their surface. RESULTS Eight samples (from seven patients) were positive for Candida. Seven of the eight were positive for Candida parapsilosis. CONCLUSIONS The whitish deposits on contact lenses are often Candida colonies that colonize the surface but do not cause an active infection in the eye. C. parapsilosis is well-known for colonizing prosthetic devices. We underline the importance of including Candida species in the differential diagnosis of lens deposits, especially in susceptible patients such as keratoprosthesis carriers.
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Affiliation(s)
- Ana Orive Bañuelos
- Department of Ophthalmology (A.O.B., A.S.C., R.F.L., C.S.E., J.E.E.), BioCruces Bizkaia Health Research Institute, University Hospital of Cruces, Barakaldo, Spain; and Department of Cell Biology and Histology (N.A.V., J.E.E.), School of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
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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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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: 19] [Impact Index Per Article: 9.5] [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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10
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Hotchkiss CE, Jeffery DA, Vogel KW. Use of Fluconazole-impregnated Beads to Treat Osteomyelitis Caused by Coccidioides in a Pigtailed Macaque ( Macaca nemestrina). Comp Med 2022; 72:273-279. [PMID: 35835541 PMCID: PMC9413521 DOI: 10.30802/aalas-cm-21-000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/27/2022] [Accepted: 04/29/2022] [Indexed: 02/03/2023]
Abstract
A 3-y-old male pigtailed macaque (Macaca nemestrina) presented for swelling of the left distal forearm and decreased use of the arm. The monkey had been raised at an indoor-outdoor facility in Arizona and transferred to an indoor facility in Washington 2 mo prior to presentation. A preliminary diagnosis of fungal osteomyelitis of the radius was made based on radiographs and Coccidioides titers. In addition to systemic antifungal treatment, surgery was performed to debride the bony lesion and implant polymethylmethacrylate beads impregnanted with the anti-fungal fluconazole. Histologic examination of the debrided material confirmed the diagnosis of fungal osteomyelitis. The surgical procedure resulted in clinical improvement, as evidenced by weight gain and decreased Coccidioides titers. The beads were removed in a second surgery, and the bony lesion completely resolved. With continued systemic fluconazole treatment, the monkey remained healthy with no further evidence of osteomyelitis. Coccidioides is an emerging pathogen that causes significant morbidity and mortality in both humans and animals. Bone infections can be resistant to systemic treatment, and the implantation of fluconazoleimpregnated beads may offer a successful treatment strategy for fungal osteomyelitis.
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Affiliation(s)
- Charlotte E Hotchkiss
- Washington National Primate Research Center, University of Washington, Seattle, Washington;,
| | - Dean A Jeffery
- Washington National Primate Research Center, University of Washington, Seattle, Washington
| | - Keith W Vogel
- Washington National Primate Research Center, University of Washington, Seattle, Washington
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11
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Koutserimpas C, Naoum S, Alpantaki K, Raptis K, Dretakis K, Vrioni G, Samonis G. Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon’s Nightmare. Diagnostics (Basel) 2022; 12:diagnostics12071606. [PMID: 35885511 PMCID: PMC9315739 DOI: 10.3390/diagnostics12071606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Fungal prosthetic joint infections (PJIs), despite the fact that they are rare, represent a devastating complication. Such infections in revised knee arthroplasties pose a unique surgical and medical challenge. A rare case of Candida parapsilosis PJI in revised knee arthroplasty is reported. Furthermore, a thorough review of all published fungal PJIs cases in revised knee arthroplasties is provided. A 72-year-old female with total knee replacement surgery due to osteoarthritis 10 years ago, followed by two revision surgeries six and two years ago due to aseptic loosening, presented with signs and symptoms of septic loosening of the knee components. Resection arthroplasty and cement-spacer placement was performed and periprosthetic tissue cultures yielded Candida parapsilosis. The patient was commenced on proper antifungal treatment (AFT) for six months and then the second stage of the revision surgery was performed successfully. From 2000 to 2022, a total of 46 patients with median age 69 years [interquartile range (IQR = 10)], suffering fungal PJI occurring in revised knee arthroplasty have been reported. The median time from initial arthroplasty to symptoms’ onset was 12 months (IQR = 14). Cultures of local material (52.2%) and histology (6.5%) were the reported diagnostic method, while Candida species were the most commonly isolated fungi. Regarding surgical management, two-stage revision arthroplasty (TSRA) was performed in most cases (54.3%), with median time-interval of six months (IQR = 6) between the two stages. Regarding AFT, fluconazole was the preferred antifungal compound (78.3%), followed by voriconazole and amphotericin B (19.6% each). The median duration of AFT was five months (IQR = 4.5). Infection’s outcome was successful in 38 cases (82.6%). Fungal PJIs, especially in revised knee arthroplasties, are devastating complications. A combination of AFT and TSRA seems to be the treatment of choice. TSRA in these cases poses a special challenge, since major bone defects may be present. Therapeutic procedures remain unclear, thus additional research is needed.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Symeon Naoum
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, “Venizeleion” General Hospital of Heraklion, 714-09 Crete, Greece;
| | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Konstantinos Dretakis
- 2nd Department of Orthopaedics, “Hygeia” General Hospital of Athens, 151-23 Marousi, Greece;
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115-27 Athens, Greece;
| | - George Samonis
- Department of Medicine, University of Crete, 71500 Heraklion, Greece
- First Department of Medical Oncology, “Metropolitan” Hospital, Neon Faliron, 185-47 Attica, Greece
- Correspondence: ; Tel.: +306-944-437-255
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12
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Karczewski D, Ren Y, Andronic O, Akgün D, Perka C, Müller M, Kienzle A. Candida periprosthetic joint infections - risk factors and outcome between albicans and non-albicans strains. INTERNATIONAL ORTHOPAEDICS 2022; 46:449-456. [PMID: 34783888 PMCID: PMC8840907 DOI: 10.1007/s00264-021-05214-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite its scarcity, fungal periprosthetic joint infection (PJI) is of great clinical relevance as diagnosis and treatment are highly challenging. Previous analyses focused on the treatment rather than the role of the causative fungal agent on clinical outcome. This is the largest study of its kind to evaluate Candida strain-dependent differences in patients with fungal PJI. METHODS We retrospectively analyzed 29 patients who underwent surgical intervention due to Candida hip or knee PJI in our department from 2010 to 2018. PJI was defined according to IDSA, recurrent PJI according to modified Delphi consensus criteria. Statistical analysis was performed using t-test, chi-square test with Yates correction, and log rank test. RESULTS Besides age and affected joint, no significant differences were found between Candida albicans and non-albicans PJI patients (75.83 versus 64.11 years, p = 0.012; 12 hip versus two knee cases, p = 0.013). Most patients received two- (27.59%) or three-stage exchange surgery (41.38%). There was a statistical trend towards an increase in surgery needed in non-albicans Candida PJI (2.92 versus 2.12; p = 0.103). After initial Candida PJI treatment, functional prosthesis implantation was achieved in 72.41% of all patients. At last follow-up, infection-free survival was at 26.79% in Candida albicans versus 72.00% in non-albicans PJI (p = 0.046). CONCLUSIONS In this study, we found infection-free survival rates to be significantly decreased in patients with albicans compared to non-albicans Candida PJI. While age and affected joint might play a confounding role, we speculate the causative pathogen to play a decisive role in disease progression.
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Affiliation(s)
- Daniel Karczewski
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Yi Ren
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Doruk Akgün
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Müller
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Arne Kienzle
- Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Charitéplatz 1, 10117, Berlin, Germany.
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13
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Physicochemical Characterization of Europium-Doped Hydroxyapatite Thin Films with Antifungal Activity. COATINGS 2022. [DOI: 10.3390/coatings12030306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Owing to its unique biological and physicochemical properties, hydroxyapatite (HAp) represents one of the most extensively studied biomaterials for biomedical applications. It is well known that Candida is currently one of the fungi frequently involved in the onset and development of post-implant infections and, owing to the appearance of antifungal resistance, it is quite difficult to treat despite all the tremendous efforts made in this regard by the scientific world. Therefore, in this context, we report for the first time in this paper, the development and characterization of europium-doped thin films (5EuHAp, xEu = 0.05) on a Si substrate by a spin-coating method. The results of ultrasound (US), zeta (ζ) potential, X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), transmission electron microscopy (TEM), scanning electron microscopy (SEM), and Fourier-transform infrared spectroscopy (FTIR) studies are presented. The XRD studies conducted on 5EuHAp suspension revealed the nanometric dimensions of the particles and sample purity. In addition, a moderate stability of the 5EuHAp suspension was observed. XPS measurements revealed the presence of Eu 3d in the 5EuHAp thin films. In the SEM micrographs, the surface uniformity and the absence of the surface defects could be observed. Moreover, the results of the FTIR studies showed the presence of the vibrational bands specific to the HAp structure in the studied sample. The antifungal activity of the HAp and 5EuHAp suspensions and coatings was evaluated using the Candida albicans ATCC 10231 (C. albicans) fungal strain. The qualitative assays of the antifungal properties of HAp and 5EuHAp coatings were also visualized by SEM and CLSM. The antifungal studies revealed that both 5EuHAp suspensions and coatings exhibited noticeable antifungal activity against C. albicans cells.
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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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15
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Enz A, Müller S, Mittelmeier W, Klinder A. Severe polymicrobial and fungal periprosthetic osteomyelitis persisting after hip disarticulations treated with caspofungin in risk patients: a case series. Ann Clin Microbiol Antimicrob 2021; 20:86. [PMID: 34972536 PMCID: PMC8720203 DOI: 10.1186/s12941-021-00490-3] [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: 03/16/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome. CASES All the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control. CONCLUSION The polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.
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Affiliation(s)
- Andreas Enz
- Orthopedic Clinic and Policlinic, University Medical Center Rostock, Doberaner Str. 142, 18057, Rostock, Germany.
| | - Silke Müller
- Institute of Pharmacology and Toxicology, University medical center Rostock, Schillingallee 70, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Orthopedic Clinic and Policlinic, University Medical Center Rostock, Doberaner Str. 142, 18057, Rostock, Germany
| | - Annett Klinder
- Orthopedic Clinic and Policlinic, University Medical Center Rostock, Doberaner Str. 142, 18057, Rostock, Germany
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16
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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: 12] [Impact Index Per Article: 4.0] [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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Baecker H, Frieler S, Geßmann J, Pauly S, Schildhauer TA, Hanusrichter Y. Three-stage revision arthroplasty for the treatment of fungal periprosthetic joint infection: outcome analysis of a novel treatment algorithm : a prospective study. Bone Jt Open 2021; 2:671-678. [PMID: 34406077 PMCID: PMC8384437 DOI: 10.1302/2633-1462.28.bjo-2021-0002.r2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Aims Fungal periprosthetic joint infections (fPJIs) are rare complications, constituting only 1% of all PJIs. Neither a uniform definition for fPJI has been established, nor a standardized treatment regimen. Compared to bacterial PJI, there is little evidence for fPJI in the literature with divergent results. Hence, we implemented a novel treatment algorithm based on three-stage revision arthroplasty, with local and systemic antifungal therapy to optimize treatment for fPJI. Methods From 2015 to 2018, a total of 18 patients with fPJI were included in a prospective, single-centre study (DKRS-ID 00020409). The diagnosis of PJI is based on the European Bone and Joint Infection Society definition of periprosthetic joint infections. The baseline parameters (age, sex, and BMI) and additional data (previous surgeries, pathogen spectrum, and Charlson Comorbidity Index) were recorded. A therapy protocol with three-stage revision, including a scheduled spacer exchange, was implemented. Systemic antifungal medication was administered throughout the entire treatment period and continued for six months after reimplantation. A minimum follow-up of 24 months was defined. Results Eradication of infection was achieved in 16 out of 18 patients (88.8%), with a mean follow-up of 35 months (25 to 54). Mixed bacterial and fungal infections were present in seven cases (39%). The interval period, defined as the period of time from explantation to reimplantation, was 119 days (55 to 202). In five patients, a salvage procedure was performed (three cementless modular knee arthrodesis, and two Girdlestone procedures). Conclusion Therapy for fPJI is complex, with low cure rates according to the literature. No uniform treatment recommendations presently exist for fPJI. Three-stage revision arthroplasty with prolonged systemic antifungal therapy showed promising results. Cite this article: Bone Jt Open 2021;2(8):671–678.
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Affiliation(s)
- Hinnerk Baecker
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Sven Frieler
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Hansjörg Wyss Hip and Pelvic Center, Swedish Hospital, Seattle, Washington, USA.,Seattle Science Foundation, Seattle, Washington, USA.,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Pauly
- Clinic for Special Orthopaedic and Trauma Surgery, Vivantes Auguste Viktoria Hospitals, Berlin, Germany
| | - Thomas A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Yannik Hanusrichter
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
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18
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Karczewski D, Khakzad T, Kriechling P, Akgün D. Aspergillus PJI - A systematic analysis of all known cases and report of a new one. J Mycol Med 2021; 31:101141. [PMID: 34274683 DOI: 10.1016/j.mycmed.2021.101141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 10/20/2022]
Abstract
Fungi resemble less than one percent of all periprosthetic joint infections (PJI). While Candida PJI is well described, Aspergillus PJI has only been reported in a few cases without any systematic analysis present at this point. This review aims to systematically summarize and describe all cases of Aspergillus PJI. The systematic review used PubMed and Cochrane Library to identify case reports and studies eligible for inclusion. One additional case was reported by the authors. T-, Mann-Whitney U- and Fisher-exact tests were used for calculations. Overall, 11 cases of Aspergillus PJI were identified, and ten could be included for a detailed analysis (four hip, four knee, one elbow, one PIP-arthroplasty infection). A. fumigatus was identified in four, A. terreus in three, and A. niger in two cases. The average patient age at time of Aspergillus spp. diagnosis was 64.1 years (32-83) and the mean time from primary implantation to Aspergillus PJI 5.2 years (1-16). The calculated CCI was 2.7 (0-6). Surgery included one-, two-, three-stage-, and spacer-exchange, debridement and resection arthroplasty. Four patients were treated with a triazole for an average of three months, three with amphotericin (mean eight weeks), one with both amphotericin (six weeks) and triazole (seven months). In one patient, reinfection with Coagulase Negative Staphylococci following Aspergillus PJI treatment was noted after four years. A. terreus (p = .048) was associated with failed prosthesis reimplantation (n = 4). To give a resume, Aspergillus PJI is a rare, yet severe complication, with heterogeneous clinical presentation. Complete prosthesis removal is the treatment of choice.
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Affiliation(s)
- Daniel Karczewski
- Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany.
| | - Thilo Khakzad
- Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany
| | - Philipp Kriechling
- Balgrist University Hospital, Department of Orthopaedics, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Doruk Akgün
- Charitè University Medicine Berlin, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany
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Lafuente-Ibáñez de Mendoza I, Cayero-Garay A, Quindós-Andrés G, Aguirre-Urizar JM. A systematic review on the implication of Candida in peri-implantitis. Int J Implant Dent 2021; 7:73. [PMID: 34136968 PMCID: PMC8209131 DOI: 10.1186/s40729-021-00338-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/30/2021] [Indexed: 01/17/2023] Open
Abstract
Background Candida is a heterogeneous fungal genus. Subgingival sulcus is a refuge for Candida, which has already been related to the pathogenic inflammation of periodontitis. This work aims to review the presence of Candida in the sulcular fluid surrounding dental implants and discuss its potential role in peri-implantitis. Results A bibliographical research was performed in PubMed, Scopus and Web of Science databases, with the keywords candida, peri-implantitis, periimplantitis, “dental implant” and implant. Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. At the end, nine observational studies were included, which analysed 400 dental implants with PI and 337 without peri-implantitis. Presence of Candida was assessed by traditional microbiological culture in blood agar or/and CHROMagar, though identification was also detected by quantitative real-time PCR, random amplified polymorphic DNA or ATB ID 32C. Dentate individuals and implants with peri-implantitis (range, 3–76.7%) had a bigger presence of Candida. C. albicans was the most isolated species, followed by Candida parapsilosis, Candida tropicalis, and Candida dubliniensis. Conclusion Candida is part of the microbiological profile of the peri-implant sulcular fluid. More studies are needed to compare the link between Candida and other microorganisms and to discover the true role of these fungi in peri-implantitis.
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Affiliation(s)
| | - Amaia Cayero-Garay
- Department of Stomatology II, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, 48940, Leioa, Vizcaya, Spain
| | - Guillermo Quindós-Andrés
- Department of Immunology, Microbiology and Parasitology, University of the Basque Country (UPV/EHU), Leioa, Vizcaya, Spain
| | - José Manuel Aguirre-Urizar
- Department of Stomatology II, University of the Basque Country (UPV/EHU), Barrio Sarriena s/n, 48940, Leioa, Vizcaya, Spain.
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20
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Enz A, Mueller SC, Warnke P, Ellenrieder M, Mittelmeier W, Klinder A. Periprosthetic Fungal Infections in Severe Endoprosthetic Infections of the Hip and Knee Joint-A Retrospective Analysis of a Certified Arthroplasty Centre of Excellence. J Fungi (Basel) 2021; 7:404. [PMID: 34064002 PMCID: PMC8224054 DOI: 10.3390/jof7060404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/01/2023] Open
Abstract
The treatment of periprosthetic joint infections (PJI), and especially of re-infections, poses a highly complex problem in orthopaedic surgery. While fungal infections are rare, they present a special challenge. The therapy is often protracted and based on limited evidence. A total of 510 hip and knee revision surgeries were analysed for the occurrence of bacterial and fungal PJI. In patients with PJI, the duration of the hospital stay and the incidence of disarticulation of the infected joint were recorded. Out of the analysed revision arthroplasties, 43.5% were due to PJI. Monomicrobial infection occurred in 55.2%, dual microbial infection in 21.4%, and polymicrobial (≥3 different bacterial or fungal species) infection in 17.2% of the cases. Overall, Candida species were detected in 12.4% cases. Candida albicans was the main fungal pathogen. In 6.9% of cases, disarticulation of the joint was the only option to control PJI. The detection of polymicrobial infection more than doubled in follow-up revisions and there was a strong association between detection of Candida infection and disarticulation (OR 9.39). The majority of fungal infections were mixed infections of bacteria and Candida albicans. The choice of a biofilm penetrating antimycotic, e.g., caspofungin, together with a sufficient standard procedure for detection and surgical treatment can help to control the infection situation. Fungal infection often proves to be more difficult to treat than anticipated and is more frequent than expected.
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Affiliation(s)
- Andreas Enz
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, 18057 Rostock, Germany; (M.E.); (W.M.); (A.K.)
| | - Silke C. Mueller
- Institute of Pharmacology and Toxicology, University Medicine Rostock, 18057 Rostock, Germany;
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany;
| | - Martin Ellenrieder
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, 18057 Rostock, Germany; (M.E.); (W.M.); (A.K.)
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, 18057 Rostock, Germany; (M.E.); (W.M.); (A.K.)
| | - Annett Klinder
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, 18057 Rostock, Germany; (M.E.); (W.M.); (A.K.)
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21
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Bottagisio M, Bidossi A, Logoluso N, Pellegrini A, De Vecchi E. A spacer infection by Candida albicans secondary to a Staphylococcus capitis prosthetic joint infection: a case report. BMC Infect Dis 2021; 21:416. [PMID: 33947342 PMCID: PMC8094554 DOI: 10.1186/s12879-021-06113-8] [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: 01/14/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most feared complications following total arthroplasty surgeries. Gram-positive bacteria are the most common microorganisms implicated in PJIs, while infections mediated by fungi only account for 1% of cases. When dealing with PJIs, a two-stage revision arthroplasty is widely used. Briefly, a spacer is introduced until re-implantation of the definitive prosthesis to provide skeleton stabilization while delivering antibiotics in the site of the infection. Sometimes, antimicrobial therapy may fail, but the isolation of a second microorganism from the spacer is uncommon and even less frequent that of a yeast. CASE PRESENTATION Here is described a case of a 75-year-old woman who underwent two-stage revision surgery of the left hip prosthesis secondary to a Staphylococcus capitis infection, whose spacer was found to be infected by Candida albicans at a later time. Briefly, the patient underwent revision surgery of the hip prosthesis for a suspected PJI. After the debridement of the infected tissue, an antibiotic-loaded spacer was implanted. The microbiological analysis of the periprosthetic tissues and the implant depicted a S. capitis infection that was treated according to the antimicrobial susceptibility profile of the clinical isolate. Three months later, the patient was admitted to the emergency room due to local inflammatory signs. Synovial fluid was sent to the laboratory for culture. No evidence of S. capitis was detected, however, a yeast was identified as Candida albicans. Fifteen days later, the patient was hospitalized for the removal of the infected spacer. Microbiological cultures confirmed the results of the synovial fluid analysis. According to the susceptibility profile, the patient was treated with fluconazole (400 mg/day) for 6 months. Seven months later, the patient underwent second-stage surgery. The microbiological tests on the spacer were all negative. After 12 months of follow-up, the patient has fully recovered and no radiological signs of infection have been detected. CONCLUSIONS Given the exceptionality of this complication, it is important to report these events to better understand the clinical outcomes after the selected therapeutic options to prevent and forestall the development of either bacterial or fungal spacer infections.
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Affiliation(s)
- Marta Bottagisio
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Via R. Galeazzi 4, 20161, Milan, Italy.
| | - Alessandro Bidossi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Via R. Galeazzi 4, 20161, Milan, Italy
| | - Nicola Logoluso
- IRCCS Istituto Ortopedico Galeazzi, Chirurgia Ricostruttiva e delle Infezioni osteo-articolari (C.R.I.O), Via R. Galeazzi 4, 20161, Milan, Italy
| | - Antonio Pellegrini
- IRCCS Istituto Ortopedico Galeazzi, Chirurgia Ricostruttiva e delle Infezioni osteo-articolari (C.R.I.O), Via R. Galeazzi 4, 20161, Milan, Italy
| | - Elena De Vecchi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Via R. Galeazzi 4, 20161, Milan, Italy
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22
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Escolà-Vergé L, Rodríguez-Pardo D, Corona PS, Pigrau C. Candida Periprosthetic Joint Infection: Is It Curable? Antibiotics (Basel) 2021; 10:antibiotics10040458. [PMID: 33920619 PMCID: PMC8073246 DOI: 10.3390/antibiotics10040458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023] Open
Abstract
Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. Typically, CPJI presents as a chronic infection in a patient with multiple previous surgeries and long courses of antibiotic therapy. In a retrospective series of cases, the surgical approach with higher rates of success consists of a two-stage exchange surgery, but the best antifungal treatment and duration of antifungal treatment are still unclear, and the efficacy of using an antifungal agent-loaded cement spacer is still controversial. Until more evidence is available, focusing on prevention and identifying patients at risk of CPJI seems more than reasonable.
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Affiliation(s)
- Laura Escolà-Vergé
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
- Correspondence: ; Tel.: +34-932-746-090; Fax: +34-934-894-091
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
| | - Pablo S. Corona
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
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23
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Garg D, Matai I, Sachdev A. Toward Designing of Anti-infective Hydrogels for Orthopedic Implants: From Lab to Clinic. ACS Biomater Sci Eng 2021; 7:1933-1961. [PMID: 33826312 DOI: 10.1021/acsbiomaterials.0c01408] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An alarming increase in implant failure incidence due to microbial colonization on the administered orthopedic implants has become a horrifying threat to replacement surgeries and related health concerns. In essence, microbial adhesion and its subsequent biofilm formation, antibiotic resistance, and the host immune system's deficiency are the main culprits. An advanced class of biomaterials termed anti-infective hydrogel implant coatings are evolving to subdue these complications. On this account, this review provides an insight into the significance of anti-infective hydrogels for preventing orthopedic implant associated infections to improve the bone healing process. We briefly discuss the clinical course of implant failure, with a prime focus on orthopedic implants. We identify the different anti-infective coating strategies and hence several anti-infective agents which could be incorporated in the hydrogel matrix. The fundamental design criteria to be considered while fabricating anti-infective hydrogels for orthopedic implants will be discussed. We highlight the different hydrogel coatings based on the origin of the polymers involved in light of their antimicrobial efficacy. We summarize the relevant patents reported in the prevention of implant infections, including orthopedics. Finally, the challenges concerning the clinical translation of the aforesaid hydrogels are described, and considerable solutions for improved clinical practice and better future prospects are proposed.
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Affiliation(s)
- Deepa Garg
- Central Scientific Instruments Organisation (CSIR-CSIO), Chandigarh-160030, India.,Academy of Scientific and Innovative Research, CSIR-CSIO, Chandigarh-160030, India
| | - Ishita Matai
- Central Scientific Instruments Organisation (CSIR-CSIO), Chandigarh-160030, India.,Academy of Scientific and Innovative Research, CSIR-CSIO, Chandigarh-160030, India
| | - Abhay Sachdev
- Central Scientific Instruments Organisation (CSIR-CSIO), Chandigarh-160030, India.,Academy of Scientific and Innovative Research, CSIR-CSIO, Chandigarh-160030, India
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24
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Kurmis AP. Eradicating Fungal Periprosthetic TKA "Super-infection": Review of the Contemporary Literature and Consideration of Antibiotic-Impregnated Dissolving Calcium Sulfate Beads as a Novel PJI Treatment Adjunct. Arthroplast Today 2021; 8:163-170. [PMID: 33855143 PMCID: PMC8024748 DOI: 10.1016/j.artd.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/07/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022] Open
Abstract
Fungal periprosthetic joint infections are an uncommon but potentially devastating complication of arthroplasty surgery. The concurrent presence of a coexistent bacterial pathogen—a so called “super-infection”—adds further complexity. With delays to definitive diagnosis and a large number of procedures before cure, the associated physical and psychological morbidity is considerable. Beyond this, the economic and resource burden can be substantial. This case report presents the successful rapid treatment of an atypical bacterial and fungal periprosthetic super-infection with two-stage revision surgery augmented with a commercially available dissolving calcium sulfate bead system permitting targeted local antifungal elution. While not the panacea for treatment, these beads provide another potentially useful tool in the atypical pathogen eradication armamentarium. Much research is still indicated to define the optimal care pathway for fungal periprosthetic super-infections.
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Affiliation(s)
- Andrew P. Kurmis
- Discipline of Medical Specialties, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
- Corresponding author. Haydown Road, Elizabeth Vale, South Australia, 5112. Australia. Tel.: +61 8 8182 9000.
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25
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Talapko J, Juzbašić M, Matijević T, Pustijanac E, Bekić S, Kotris I, Škrlec I. Candida albicans-The Virulence Factors and Clinical Manifestations of Infection. J Fungi (Basel) 2021; 7:79. [PMID: 33499276 PMCID: PMC7912069 DOI: 10.3390/jof7020079] [Citation(s) in RCA: 195] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
Candida albicans is a common commensal fungus that colonizes the oropharyngeal cavity, gastrointestinal and vaginal tract, and healthy individuals' skin. In 50% of the population, C. albicans is part of the normal flora of the microbiota. The various clinical manifestations of Candida species range from localized, superficial mucocutaneous disorders to invasive diseases that involve multiple organ systems and are life-threatening. From systemic and local to hereditary and environmental, diverse factors lead to disturbances in Candida's normal homeostasis, resulting in a transition from normal flora to pathogenic and opportunistic infections. The transition in the pathophysiology of the onset and progression of infection is also influenced by Candida's virulence traits that lead to the development of candidiasis. Oral candidiasis has a wide range of clinical manifestations, divided into primary and secondary candidiasis. The main supply of C. albicans in the body is located in the gastrointestinal tract, and the development of infections occurs due to dysbiosis of the residential microbiota, immune dysfunction, and damage to the muco-intestinal barrier. The presence of C. albicans in the blood is associated with candidemia-invasive Candida infections. The commensal relationship exists as long as there is a balance between the host immune system and the virulence factors of C. albicans. This paper presents the virulence traits of Candida albicans and clinical manifestations of specific candidiasis.
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Affiliation(s)
- Jasminka Talapko
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
| | - Martina Juzbašić
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
| | - Tatjana Matijević
- Department of Dermatology and Venereology, Clinical Hospital Center Osijek, HR-31000 Osijek, Croatia;
| | - Emina Pustijanac
- Faculty of Natural Sciences, Juraj Dobrila University of Pula, HR-52100 Pula, Croatia;
| | - Sanja Bekić
- Family Medicine Practice, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia
| | - Ivan Kotris
- Department of Internal Medicine, General County Hospital Vukovar, HR-3200 Vukovar, Croatia;
| | - Ivana Škrlec
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, HR-31000 Osijek, Croatia; (J.T.); (M.J.)
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26
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Mafrachi BW, Debei AHA, Muhtaseb FMA, Al-Ajlouni JM, Hammad YS. Fungal Prosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report. J Orthop Case Rep 2021; 11:95-98. [PMID: 34141680 PMCID: PMC8180338 DOI: 10.13107/jocr.2021.v11.i02.2042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Prosthetic joint infection (PJI) is a rare complication of total knee replacement (TKR), yet it is a serious and debilitating condition. Bacterial infection accounts for the majority of cases and fungal infection is estimated to cause 1% of all prosthesis infection. Case Report: This case presents a 60years female, who presented to our outpatient orthopedic clinic complaining of right knee pain, swelling, and hotness. The physical examination revealed redness, hotness, restricted range of movement, and tibial loosening, 9 months following TKR revision. Culture of the joint aspirate showed growth of “Candida parapsilosis” and second aspirate confirmed the diagnosis. The patient then underwent two stages revision surgery with placement of amphotericin B loaded cement, to maintain high local antifungal concentration in addition to decrease the side effects of amphotericinB infusion such as thrombophlebitis and the more serious systemic effect as nephrotoxicity. The post-operative course was uneventful, with gradual improvement and restoration of normal movement range. Conclusion: Fungal PJI is a rare complication of TKR, yet it results in severe debilitating symptoms and impairment of the patient functional capacity. Careful evaluation of the patient followed by a detailed workup is necessary for the identification of the underlying causative micro-organism. Two-stage revision surgery with antifungal loaded cement spacer and antifungal therapy currently is the standard of management. To the best of our knowledge, this is the first fungal PJI following total knee arthroplasty reported in Jordan.
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Affiliation(s)
| | | | | | - Jihad M Al-Ajlouni
- Department of Orthopaedic Surgery, University of Jordan and Jordan University Hospital, Aljubeiha, Amman, Jordan
| | - Yazan S Hammad
- Department of Orthopaedic Surgery, University of Jordan and Jordan University Hospital, Aljubeiha, Amman, Jordan
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27
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Baptista M, Sevivas N, Ferreira NV, Fardilha L, Varanda P, Mateus C. Cryptococcus magnus Periprosthetic Shoulder Infection: A Case Report. JBJS Case Connect 2020; 10:e20.00507. [PMID: 33512932 DOI: 10.2106/jbjs.cc.20.00507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a 68-year-old diabetic man with a periprosthetic shoulder infection (PSI) by Cryptococcus magnus. The fungus was identified 4 weeks after a revision surgery for a chronic bacterial PSI. Treatment was successful with a 2-week course of intravenous liposomal amphotericin B (5 mg/kg) followed by 6 weeks of fluconazole (200 mg/d). CONCLUSION To the best of our knowledge, only 2 periprosthetic infections due to Cryptococcus neoformans have been previously reported. This is the first report of cryptococcal involvement of a prosthetic shoulder, and the first identified osteoarticular infection ever by C. magnus.
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Affiliation(s)
- Mário Baptista
- Orthopaedic Surgery and Traumatology Department, Hospital de Braga, Braga, Portugal
| | - Nuno Sevivas
- Trofa Saúde Group, Porto, Portugal.,School of Medicine and ICVS/3B's-PT Government Associate Laboratory, University of Minho, Braga, Portugal
| | - Nuno Vieira Ferreira
- Trofa Saúde Group, Porto, Portugal.,Orthopaedic Surgery and Traumatology Department, Hospital Santa Maria Maior, Barcelos, Portugal
| | - Luísa Fardilha
- Orthopaedic Surgery and Traumatology Department, Hospital de Braga, Braga, Portugal
| | - Pedro Varanda
- Orthopaedic Surgery and Traumatology Department, Hospital de Braga, Braga, Portugal.,School of Medicine and ICVS/3B's-PT Government Associate Laboratory, University of Minho, Braga, Portugal
| | - Carlos Mateus
- Orthopaedic Surgery and Traumatology Department, Hospital de Braga, Braga, Portugal
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28
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Dauben TJ, Dewald C, Firkowska-Boden I, Helbing C, Peisker H, Roth M, Bossert J, Jandt KD. Quantifying the relationship between surfaces' nano-contact point density and adhesion force of Candida albicans. Colloids Surf B Biointerfaces 2020; 194:111177. [PMID: 32569885 DOI: 10.1016/j.colsurfb.2020.111177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/11/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
Abstract
It has been recently recognized that controlled surface structuring on the nanometer scale is a successful strategy to endow different materials with antimicrobial properties. Despite many studies on bacterial interactions with nanostructured surfaces, a quantitative link between surface topography and bacterial adhesion is still missing. To quantitatively link cell adhesion data with topographical surface parameters, we performed single-cell spectroscopy on chemically identical surfaces with controlled nano-contact point density achieved by immobilization of gold nanoparticles (AuNP) on gold thin films. Such materials surfaces have previously shown antimicrobial (anti-adhesive) efficacy towards Gram-negative Escherichia coli cells. In the current study, the influence of nano-structured surfaces on the surface coverage and adhesion forces of clinically relevant Candida albicans (C. albicans), the fungus primarily associated with implant infections, was investigated to validate their antimicrobial potency against different microbial cells. The adhesion forces of C. albicans cells to nanostructured surfaces showed a decreasing trend with decreasing contact-point density and correlated well with the results of the respective C. albicans cell counts. The surfaces with the lowest contact-point density, 25 AuNP/μm², resulted in an average adhesion force of 5 nN, which was up to 5 times lower compared to control and 61 AuNP/μm² surfaces. Further, detailed analyses of force-distance curves revealed that the work of adhesion, and thus the energy required to remove the C. albicans cell from the surface is up to 10 times lower on 25 AuNP/μm² surfaces compared to unstructured surfaces. These findings show that a controlled tuning of nanostructured surfaces in terms of accessible nano-contact points is crucial to generate surface structures with enhanced antimicrobial properties. The gained knowledge can be further exploited for the design of biomaterials surfaces to prevent adhesion of some most commonly encountered pathogens.
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Affiliation(s)
- Thomas J Dauben
- Chair of Materials Science (CMS), Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Carolin Dewald
- Chair of Materials Science (CMS), Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Adolf-Reichwein-Straße 23, 07745 Jena, Germany; Jena School for Microbial Communication (JSMC), Neugasse 23, 07743 Jena, Germany
| | - Izabela Firkowska-Boden
- Chair of Materials Science (CMS), Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany.
| | - Christian Helbing
- Chair of Materials Science (CMS), Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Henrik Peisker
- Institute for Medical Microbiology and Hygiene, Saarland University Clinic, Kirrberger Straße Building 43, 66421 Homburg, Saar, Germany
| | - Martin Roth
- Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute (HKI), Adolf-Reichwein-Straße 23, 07745 Jena, Germany; Jena School for Microbial Communication (JSMC), Neugasse 23, 07743 Jena, Germany
| | - Jörg Bossert
- Chair of Materials Science (CMS), Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany
| | - Klaus D Jandt
- Chair of Materials Science (CMS), Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany; Jena School for Microbial Communication (JSMC), Neugasse 23, 07743 Jena, Germany.
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29
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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: 75] [Impact Index Per Article: 18.8] [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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Prosthetic Joint Infection of a Revision Knee Arthroplasty with Candida parapsilosis. Case Rep Orthop 2019; 2019:3634519. [PMID: 31934480 PMCID: PMC6942732 DOI: 10.1155/2019/3634519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/22/2019] [Indexed: 01/10/2023] Open
Abstract
We report a case of an infected total knee arthroplasty with Candida parapsilosis. The patient was successfully treated with a two-stage exchange arthroplasty, local antifungal treatment, and systemic antifungal treatment. This specific combination therapy to treat C. parapsilosis joint infection has not been previously reported.
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Abstract
Fungal periprosthetic joint infection (PJI) is a devastating complication because it can be difficult to diagnose, manage, and eradicate. Fungal PJI treatment requires a systematic approach. Increased awareness is essential when patients with painful arthroplasties present with immunosuppression, significant comorbidities, multiple surgeries, and history of drug use. Every suspected fungal PJI should be promptly diagnosed using readily available serum and synovial fluid markers. Surgical management involves débridement, antibiotics, and implant retention, one-stage exchange arthroplasty, prosthetic articulating spacers, and two-stage exchange arthroplasty. Because mycotic infections develop robust biofilms, the utility of débridement, antibiotics, and implant retention and one-stage revisions seem limited. A thorough irrigation and débridement is essential to decrease infection burden. Adjunctive local and systemic antifungal therapy is critical, although the agent choice and duration should be tailored appropriately. Future high-quality studies are needed to develop standardized guidelines for the management of fungal PJI.
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Roberts SC, Zembower TR, Bolon MK, Kadakia AR, Gilley JH, Ko JH, Clark J, Ward-Fore S, Taiwo BO. Successful treatment of a Candida auris intra-articular infection. Emerg Microbes Infect 2019; 8:866-868. [PMID: 31179850 PMCID: PMC6566482 DOI: 10.1080/22221751.2019.1625287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A 78-year-old woman with a long-term ankle spacer with antibacterials developed an intra-articular Candida auris infection. Treatment with systemic antifungal therapy plus an amphotericin B moulded cement spacer was successful.
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Affiliation(s)
- Scott C Roberts
- a Division of Infectious Diseases , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Teresa R Zembower
- a Division of Infectious Diseases , Northwestern University Feinberg School of Medicine , Chicago , IL , USA.,b Department of Pathology , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Maureen K Bolon
- a Division of Infectious Diseases , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Anish R Kadakia
- c Division of Orthopaedic Surgery , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Jasen H Gilley
- c Division of Orthopaedic Surgery , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Jason H Ko
- d Division of Plastic Surgery , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Jessica Clark
- a Division of Infectious Diseases , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Sharon Ward-Fore
- a Division of Infectious Diseases , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Babafemi O Taiwo
- a Division of Infectious Diseases , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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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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Sanabria A, Røkeberg MEO, Johannessen M, Sollid JE, Simonsen GS, Hanssen AM. Culturing periprosthetic tissue in BacT/Alert® Virtuo blood culture system leads to improved and faster detection of prosthetic joint infections. BMC Infect Dis 2019; 19:607. [PMID: 31291897 PMCID: PMC6621959 DOI: 10.1186/s12879-019-4206-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Blood culture bottles (BCBs) provide a semiautomated method for culturing periprosthetic tissue specimens. A study evaluating BCBs for culturing clinical samples other than body fluids is needed before implementation into clinical practice. Our objective was to evaluate use of the BacT/Alert® Virtuo blood culture system for culturing periprosthetic tissue specimens. Methods The study was performed through the analysis of spiked (n = 36) and clinical (n = 158) periprosthetic tissue samples. Clinical samples were analyzed by the BCB method and the results were compared to the conventional microbiological culture-based method for time to detection and microorganisms identified. Results The BacT/Alert® Virtuo blood culture system detected relevant bacteria for prosthetic joint infection in both spiked and clinical samples. The BCB method was found to be as sensitive (79%) as the conventional method (76%) (p = 0.844) during the analyses of clinical samples. The BCB method yielded positive results much faster than the conventional method: 89% against 27% detection within 24 h, respectively. The median detection time was 11.1 h for the BCB method (12 h and 11 h for the aerobic and the anaerobic BCBs, correspondingly). Conclusion We recommend using the BacT/Alert® Virtuo blood culture system for analyzing prosthetic joint tissue, since this detect efficiently and more rapidly a wider range of bacteria than the conventional microbiological method. Electronic supplementary material The online version of this article (10.1186/s12879-019-4206-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adriana Sanabria
- Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.
| | - Merethe E O Røkeberg
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Mona Johannessen
- Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Johanna Ericson Sollid
- Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Gunnar Skov Simonsen
- Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Anne-Merethe Hanssen
- Research Group for Host-Microbe Interactions, Department of Medical Biology, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
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Fusini F, Aprato A, Massè A, Bistolfi A, Girardo M, Artiaco S. Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes. INTERNATIONAL ORTHOPAEDICS 2019; 44:15-22. [DOI: 10.1007/s00264-019-04369-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/19/2019] [Indexed: 12/12/2022]
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Pasticci MB, Papalini C, Leli A, Bruno G. Two-stage revision and systemic antifungal therapy of Candida glabrata primary prosthetic hip infection successfully treated: a case report. J Med Case Rep 2019; 13:151. [PMID: 31109363 PMCID: PMC6528250 DOI: 10.1186/s13256-019-2095-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Overall, fungi are estimated to cause approximately 1% of prosthetic joint infections, Candida glabrata account for less than 10% of these cases. No well-defined treatment strategy is available. CASE PRESENTATION A 71-year-old Caucasian man with non-insulin-dependent diabetes was admitted for hip prosthesis revision. For the past 17 years he suffered from recurrent infection of a perianal fistula, the last episode being 1 week before admission, and was prescribed amoxicillin/clavulanate 1 g twice a day. At surgery, the synovial fluid tested positive for infection with the Synovasure® Alpha Defensin Test, and the orthopedic surgeon reported intraoperative evidence of infection. While the synovial fluid failed to grow microorganisms, seven different samples including periprosthetic tissue and the prosthesis grew Candida glabrata. Imipenem 2 g and teicoplanin 600 mg daily were administered during surgery. Also an antibiotic loaded spacer was positioned. A week later micafungin 100 mg a day was added, and after another week imipenem was replaced with ertapenem 1 g once a day. The combination of antibiotics and antifungal was administered for a total of 7 weeks, while he also underwent treatment of the perianal fistula. The reimplantation was performed after an 8-week antibiotic-free interval. Before reimplantation, his erythrocyte sedimentation rate and C-reactive protein level were normal. At reimplant surgery, several samples were collected for microbiology, before administering ertapenem 1 g, teicoplanin 600 mg and micafungin 100 mg once a day. This antimicrobial combination was continued for 15 days until the microbiologic investigations, including culture and molecular testing after sonication technique of the spacer, were reported negative for bacteria and fungi. In this patient, systemic antifungal and extensive debridement allowed for clinical and microbiologic cure. CONCLUSIONS Although Candida glabrata prosthetic joint infection is a rare event, the incidence could increase in the future, and there is need for more definitive treatment protocols. Diagnosis depends on culture. Fungal etiology must always be included in the differential diagnosis of prosthetic joint infection.
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Affiliation(s)
- Maria Bruna Pasticci
- 0000 0004 1757 3630grid.9027.cInfectious Disease Clinic, Medicine Department, University of Perugia, Perugia, Italy
| | - Chiara Papalini
- 0000 0004 1757 3630grid.9027.cInfectious Disease Clinic, Medicine Department, University of Perugia, Perugia, Italy
| | - Andrea Leli
- Orthopedic Unit, Branca Hospital, Azienda Sanitaria Umbria 1, Perugia, Italy
| | - Gastone Bruno
- Orthopedic Unit, Branca Hospital, Azienda Sanitaria Umbria 1, Perugia, Italy
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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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Kuo FC, Goswami K, Shohat N, Blevins K, Rondon AJ, Parvizi J. Two-Stage Exchange Arthroplasty Is a Favorable Treatment Option Upon Diagnosis of a Fungal Periprosthetic Joint Infection. J Arthroplasty 2018; 33:3555-3560. [PMID: 30150154 DOI: 10.1016/j.arth.2018.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/12/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study investigated the prevalence of medical comorbidities, risk factors, and treatment outcomes in patients with fungal periprosthetic joint infection (PJI). METHODS All patients with fungal PJI treated from 1999 to 2014 were retrospectively identified at a single institution. Demographic data, comorbidity, and surgical variables were obtained from medical records. Patients were followed up for at least 2 years. PJI was diagnosed using the Musculoskeletal Infection Society criteria. Treatment success was defined using the Delphi consensus criteria. Kaplan-Meier survivorship curves with 95% confidence interval were used for analysis. RESULTS Overall, fungal PJIs accounted for 2.4% of the PJI treated at our institution. Twenty-seven patients (93.1%) had 2 or more underlying systemic illnesses. Age and revision surgery were significant risk factors for development of fungal PJI after adjusting for confounding variables. Overall treatment success was 55.2% at 1 year and 40.5% at 5 years. When stratified by initial surgical management, treatment success was 57.1% at 1 year and 28.6% at 5 years following irrigation and debridement; 33.3% at 1 year and 5 years following 1-stage revision; and 57.9% at 1 year and 46.3% at 5 years for 2-stage exchange arthroplasty. CONCLUSION Patients with fungal PJI have a high prevalence of systemic illness and poor outcome after surgical management. Irrigation and debridement and single-stage revision demonstrate poor longterm outcomes and may have no place as treatment choices for fungal PJI. Moving forward, our efforts should concentrate on optimizing the systemic status of these patients prior to 2-stage exchange arthroplasty.
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Affiliation(s)
- Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Karan Goswami
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Noam Shohat
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Kier Blevins
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | | | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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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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Lee YR, Kim HJ, Lee EJ, Sohn JW, Kim MJ, Yoon YK. Prosthetic Joint Infections Caused by Candida Species: A Systematic Review and a Case Series. Mycopathologia 2018; 184:23-33. [PMID: 30051279 DOI: 10.1007/s11046-018-0286-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to evaluate the efficacy of echinocandins in the treatment of Candida prosthetic joint infection (PJI) based on published literature and on patients we examined. A structured literature review of multiple databases was conducted to identify patients who received echinocandins for Candida PJIs. Additionally, we describe here the first cases of PJIs due to C. parapsilosis, successfully treated with prolonged anidulafungin therapy. Out of 17 patients, 12 were female and the mean age at diagnosis was 66.0 years. No risk factors associated with Candida PJIs were found in four patients (23.5%). Infection sites included the knee (n = 10, 62.5%), the hip (n = 6, 35.3%) and the shoulder (n = 1, 5.9%). The most frequently isolated Candida species were C. albicans (n = 7, 41.2%) and C. glabrata (n = 7, 41.2%), followed by C. parapsilosis (n = 2, 11.8%) and C. freyschussii (n = 1, 5.9%). All patients were cured with the combination of systemic antifungal therapy and surgical interventions. Two-stage exchange arthroplasty and resection arthroplasty were performed in five and nine patients, respectively. The most frequently used echinocandins were caspofungin (n = 11, 64.7%), followed by anidulafungin (n = 4, 23.5%) and micafungin (n = 2, 11.8%). The median duration (days) of echinocandin therapy was as follows: caspofungin (25.5, range 8-56), micafungin (14.0, range 4-56) and anidulafungin (58, range 14-90). This study supports the effective role of echinocandins, as well as the potential advantage of surgical intervention in the treatment of Candida PJIs. Furthermore, it provides fundamental data on the safety of long-term echinocandin therapy.
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Affiliation(s)
- Yoo Ra Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Institute for Evidence-Based Medicine, Cochrane Korea, Seoul, Republic of Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Ju Lee
- Medical Library, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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Koutserimpas C, Samonis G, Velivassakis E, Iliopoulou-Kosmadaki S, Kontakis G, Kofteridis DP. Candida glabrata
prosthetic joint infection, successfully treated with anidulafungin: A case report and review of the literature. Mycoses 2018; 61:266-269. [DOI: 10.1111/myc.12736] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/13/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology; University Hospital of Heraklion; Crete Greece
| | - George Samonis
- Department of Internal Medicine; Infectious Diseases Unit; University Hospital of Heraklion; Crete Greece
| | - Emmanouil Velivassakis
- Department of Orthopaedics and Traumatology; University Hospital of Heraklion; Crete Greece
| | | | - Georgios Kontakis
- Department of Orthopaedics and Traumatology; University Hospital of Heraklion; Crete Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine; Infectious Diseases Unit; University Hospital of Heraklion; Crete Greece
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