<i>Candida</i> fracture-related infection: a systematic review

Abstract

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.

Epidemiology and Drug Resistance of Fracture-Related Infection of the Long Bones of the Extremities: A Retrospective Study at the Largest Trauma Center in Southwest China

“…At the same time, we noted that the total number of infections showed a downward trend with the passage of time, which may be related to our trauma treatment policy and the improvement in medical standards. No fungus-induced FRI was observed in our study, which occurs most often in immunosuppressed populations and in those receiving long-term non-standard broad-spectrum antibiotic therapy ( De Meo et al, 2021 ).…”

Microbiology of fracture related infections

“…Although rare, there have been reports of fungal fracture related infections. A systematic review in 2021 64 reported 5 cases of candida grown on samples from FRI. Risk factors for fungal infection included open wounds, prolonged antibiotic therapy and immunodeficiency. The reoperation rate was 33% and prolonged antifungal therapy was required (mean time 8.8 weeks).…”

Impact of Anti-Mycotic Drugs on the Osteogenic Response of Bone Marrow Mesenchymal Stem Cells In Vitro

“…While most infections are caused by bacteria, fungal infections are accountable for 1% of all prosthetic joint infections, and they often require multiple surgeries with a temporary removal of the prosthesis to cure 2 of 24 the infection, if possible at all [6,7,10]. Nevertheless, re-infections are common, and they lead to even higher mortality rates [6,7] Fungal infections of fractures are less prevalent than fungal infections in total joint arthroplasty [11]. The most frequent cause of fracture infections is the direct inoculation of open fractures or traumatic injuries contaminated with soil [12][13][14].…”