Laura Escolà-Vergé1, Dolors Rodríguez-Pardo2, Jaime Lora-Tamayo3, Laura Morata4, Oscar Murillo5, Helem Vilchez6, Luisa Sorli7, Laura Guío Carrión8, José Mª Barbero9, Julián Palomino-Nicás10, Alberto Bahamonde11, Alfredo Jover-Sáenz12, Natividad Benito13, Rosa Escudero14, Marta Fernandez Sampedro15, Rafael Pérez Vidal16, Lucía Gómez17, Pablo S Corona18, Benito Almirante2, Javier Ariza5, Carles Pigrau2. 1. Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address: lescola@vhebron.net. 2. Infectious Diseases Department, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain. 3. Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre "i+12", Madrid, Spain. 4. Infectious Diseases Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. 5. Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain. 6. Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Palma, Spain. 7. 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. 8. Infectious Diseases Unit, Hospital Universitario Cruces, Bilbao, Spain. 9. Internal Medicine Department, Hospital Príncipe de Asturias, Universidad de Alcalá de Henares, Madrid. 10. Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain. 11. Internal Medicine Department, Hospital El Bierzo, Ponferrada, Spain. 12. Infectious Diseases Department, Unidad Territorial para el control de la Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova, Lleida, Spain. 13. 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. 14. Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain. IRYCIS. 15. Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, Cantabria, Spain. 16. Infectious Diseases Unit, Internal Medicine Department, Althaia, Hospital de Sant Joan de Déu, Manresa, Spain. 17. Internal Medicine, Hospital Universitari Mútua de Terrassa, Barcelona, Spain. 18. Reconstructive and Septic Surgery Division, Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, VHIR, Universitat Autònoma de Barcelona, Barcelona, Spain.
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.
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.
Authors: Talha Riaz; Aaron J Tande; Lisa L Steed; Harry A Demos; Cassandra D Salgado; Douglas R Osmon; Camelia E Marculescu Journal: J Bone Jt Infect Date: 2020-03-26
Authors: Dariusz Grzelecki; Aleksandra Grajek; Piotr Dudek; Łukasz Olewnik; Nicol Zielinska; Petr Fulin; Maria Czubak-Wrzosek; Marcin Tyrakowski; Dariusz Marczak; Jacek Kowalczewski Journal: J Fungi (Basel) Date: 2022-07-29