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Candida periprosthetic joint infection: A rare and difficult-to-treat infection

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dc.contributor.author Escolà-Vergé, Laura
dc.contributor.author Sorli Redó, M. Luisa
dc.contributor.author Pigrau, C.
dc.contributor.author Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC)
dc.contributor.author Spanish Network for Research in Infectious Pathology (REIPI)
dc.date.accessioned 2019-06-03T07:41:09Z
dc.date.issued 2018
dc.identifier.citation Escolà-Vergé L, Rodríguez-Pardo D, Lora-Tamayo J, Morata L, Murillo O, Vilchez H. et al. Candida periprosthetic joint infection: A rare and difficult-to-treat infection. J Infect. 2018 Aug;77(2):151-157. DOI: 10.1016/j.jinf.2018.03.012
dc.identifier.issn 0163-4453
dc.identifier.uri http://hdl.handle.net/10230/41684
dc.description.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.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Elsevier
dc.rights © Elsevier http://dx.doi.org/10.1016/j.jinf.2018.03.012
dc.title Candida periprosthetic joint infection: A rare and difficult-to-treat infection
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1016/j.jinf.2018.03.012
dc.subject.keyword 2-stage treatment
dc.subject.keyword Antibiofilm agents
dc.subject.keyword Antifungal-loaded bone cement
dc.subject.keyword Candida
dc.subject.keyword Echinocandins
dc.subject.keyword Fungal periprosthetic infection
dc.rights.accessRights info:eu-repo/semantics/embargoedAccess
dc.type.version info:eu-repo/semantics/acceptedVersion
dc.embargo.liftdate 2019-08-31
dc.date.embargoEnd info:eu-repo/date/embargoEnd/2019-08-31

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