Fungal Periprosthetic Hip Joint Infections

Abstract

Introduction: Fungal hip prosthetic joint infections (PJIs) are rare but severe infections. Their incidence has increased in the last decades due to the aging population, as well as due to the increased number of immunosuppressed hosts. The present review of all published fungal PJIs in hip arthroplasties aims to present as much data as possible for both medical and surgical treatment options, so that the best applicable management may be concluded. Methods: A meticulous review of all published fungal hip PJIs was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 89 patients suffering fungal hip PJI were identified. The patients’ mean age was 66.9 years. The mean time from initial arthroplasty to onset of symptoms was 69.3 months, while 40.4% of the patients were immunocompromised. The most common imaging method indicating diagnosis was plain X-ray or CT scan (20.2%), while definite diagnosis had become possible through cultures in most cases (98.9%), and/or histology (44.9%). The most frequently isolated fungus was C. albicans (49.4%), followed by C. parapsilosis (18%) and C. glabrata (12.4%), while bacterial co-infection was present in 32 cases (36%). Two-stage revision arthroplasty (TSRA) was the most commonly performed procedure (52.8%), with mean time between the two stages = 7.9 months. Regarding antifungal treatment (AFT), fluconazole was the preferred agent (62.9%), followed by amphotericin B (36%), while the mean duration of AFT was 5.1 months. Outcome was successful in 68 cases (76.4%). Conclusions: Both diagnosis and management of fungal PJIs in patients having undergone total hip arthroplasty are quite demanding. A multidisciplinary approach is of utmost importance, since the combination of AFT and TSRA appears to be the proper treatment method.

Different Biomarker Ratios in Peripheral Blood have Limited Value in Diagnosing Periprosthetic Joint Infection after Artificial Joint Replacement：A Single-Center, Retrospective Study

“…However, preoperative diagnosis of PJI is still di cult due to the emergence of infections caused by speci c pathogens and bacterial bio lm formation. [7][8][9][10][11] Although diagnostic techniques such as leukocyte esterase (LE),defensin, PCR, NGS and others have shown the potential to improve diagnostic accuracy, their high technical complexity and medical costs limit their widespread use. [14][15][16]23 Against this backdrop, our study focused on the clinical utility of readily available The ESR and CRP are important biomarkers re ecting the presence of in ammation in the body.…”

Different biomarker ratios in peripheral blood have limited value in diagnosing periprosthetic joint infection after total joint arthroplasty: a single-center, retrospective study

“…Studies have revealed that more than 25% of TKA revisions are attributable to PJI [ 20 ], underscoring the importance of timely diagnosis for effective treatment planning and optimal therapeutic outcomes. However, preoperative diagnosis of PJI is still difficult due to the emergence of infections caused by specific pathogens and bacterial biofilm formation [ 1 – 4 ]. Although diagnostic techniques such as leukocyte esterase (LE), ɑ-defensin, PCR, NGS and others have shown the potential to improve diagnostic accuracy, their high technical complexity and medical costs limit their widespread use [ 10 – 12 , 21 ].…”

“…Currently, the diagnosis of periprosthetic joint infection (PJI) still relies heavily on the culture of pathogenic microorganisms, which is widely considered the "gold standard" [ 1 ]. However, with the emergence of specific pathogen infections such as mycobacteria, Brucella, and fungi and the formation of bacterial biofilms, these factors may diminish the detection rate of pathogens and exacerbate the challenges in PJI diagnosis and treatment [ 2 – 4 ]. Approximately 5%-42% of PJI patients are estimated to demonstrate negative results for pathogenic microorganisms [ 5 ].…”

Our current clinical understanding of Candida biofilms: where are we two decades on?

“…Prosthetic joint infection (PJI) is a significant complication to an otherwise ordinarily successful procedure and presents a significant issue for post‐clinical management when fungi are present. In a recent review of fungal periprosthetic joint infections comprising of 89 patients, C. albicans was the most common clinical isolate (49.4%), followed by C. parapsilosis (18%) and C. glabrata (12.4%) (84). In another meta‐analysis from 2009 to 2019 it was reported that 286 patients had a fungal periprosthetic infection of the knee, hip, shoulder, or elbow.…”