RT Journal Article
T1 Candida periprosthetic joint infection: A rare and difficult-to-treat infection.
A1 Escola-Verge, Laura
A1 Rodriguez-Pardo, Dolors
A1 Lora-Tamayo, Jaime
A1 Morata, Laura
A1 Murillo, Oscar
A1 Vilchez, Helem
A1 Sorli, Luisa
A1 Guio-Carrion, Laura
A1 Barbero, José Mª
A1 Palomino-Nicas, Julian
A1 Bahamonde, Alberto
A1 Jover-Saenz, Alfredo
A1 Benito, Natividad
A1 Escudero, Rosa
A1 Fernandez-Sampedro, Marta
A1 Vidal, Rafael Pérez
A1 Gomez, Lucia
A1 Corona, Pablo S
A1 Almirante, Benito
A1 Ariza, Javier
A1 Pigrau, Carles
K1 2-stage treatment
K1 Antibiofilm agents
K1 Antifungal-loaded bone cement
K1 Candida
K1 Echinocandins
K1 Fungal periprosthetic infection
AB 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. We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 in 16 Spanish hospitals. 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%. 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.
PB Elsevier Ltd
YR 2018
FD 2018-05-07
LK http://hdl.handle.net/10668/12444
UL http://hdl.handle.net/10668/12444
LA en
NO 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.
DS RISalud
RD Apr 12, 2025