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

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.

Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature

“…A total of 63 studies on fungal PJI were found. A total of 372 fungal PJI cases were retrieved, most of which were collected from case reports [ 12 , 14 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ], small case series [ 15 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ...…”

Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads

“…The non-exothermic setting of CaSO 4 allows for almost all antimicrobial agents to be utilized (McPherson et al, 2021;Laycock et al, 2018). In PJI treatment, antibiotic-loaded CaSO 4 (ALCS) has been utilized since the late 1990s and ALCS application continues to evolve (Andreacchio et al, 2019;Kenna et al, 2018;Kurmis, 2021;Luo et al, 2016;Morley et al, 2022;Trujillo et al, 2017;Zhang et al, 2020;Ferguson et al, 2014;Abosala and Ali, 2020).…”