Fungal Periprosthetic Joint Infection: A Review of Demographics and Management

Gross, Christopher; Valle, Craig J. Della; Rex, James; Traven, Sophia A.; Durante, Elizabeth C.

doi:10.1016/j.arth.2020.11.005

Cited by 38 publications

(51 citation statements)

References 38 publications

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“…The largest review analyzing various fungal PJIs included 32 articles and was performed on data collected from 286 cases [ 7 ]. However, this study included PJIs after THA (139 cases), TKA (142 cases), total elbow (two cases) and shoulder (three cases) arthroplasties.…”

Section: Discussionmentioning

confidence: 99%

“…The analyses performed on larger cohorts concern data collected from several centers [ 13 , 14 , 15 ], or from systematic reviews [ 16 , 17 ]. Currently, two-stage revisions are known as the gold standard for the treatment of bacterial PJI and were also reported as a preferable protocol in those caused by fungal pathogens [ 7 , 10 , 18 , 19 , 20 ]. However, one-stage surgical strategies are also performed with good results in different orthopedic centers [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Candida species are the most common fungal pathogens identified in approximately 85% of all mycological cultures [ 7 ]. Among these, Candida albicans and Candida parapsilosis are the most frequent isolates (55–65% and 13–33%, respectively) [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Periprosthetic Joint Infections Caused by Candida Species—A Single-Center Experience and Systematic Review of the Literature

Grzelecki

Grajek²,

Dudek

et al. 2022

JoF

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Background: The aim of this study was to analyze the treatment results of fungal periprosthetic joint infections (PJI) caused by Candida species from a single orthopedic center and to compare them with reports from other institutions. Methods: Eight patients operated on from January 2014 to December 2021 met the inclusion criteria and were analyzed in terms of clinical outcomes. A systematic review of the literature identified 153 patients with Candida PJIs extracted from 12 studies according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. Results: The success rate of the treatment in the case series was 50%. The most frequent pathogens were Candida albicans (three cases; 37.5%) and Candida parapsilosis (three cases; 37.5%). In one patient (12.5%), bacterial co-infection was noted, and in five patients (62.5%) significant risk factors of PJI were confirmed. The overall success rate on the basis of data collected for systematic review was 65.5%. A sub-analysis of 127 patients revealed statistically significant differences (p = 0.02) with a higher success rate for the knees (77.6%) than for the hips (58%). In 10 studies the analysis of risk factors was performed and among 106 patients in 77 (72.6%) comorbidities predispose to fungal PJI were confirmed. Bacterial co-infection was noted in 84 patients (54.9%). In 93 patients (60.7%) Candida albicans was the culprit pathogen, and in 39 patients (25.5%) Candida parapsilosis was the culprit pathogen. Based on these two most frequent Candida species causing PJI, the success rate of the treatment was statistically different (p = 0.03), and was 60.3% and 83.3%, respectively. The two-stage strategy was more favorable for patients with Candida parapsilosis infections (94.4% success rate) than the one-stage protocol (50% success rate; p = 0.02); as well as in comparison to the two-stage treatment of Candida albicans (65% success rate; p = 0.04). Conclusions: The analysis of the literature showed no differences in the overall success rate between one- and two-stage surgical strategies for all Candida species, but differed significantly comparing the two most frequent strains and concerning PJI localization. The frequent presence of bacterial co-infections makes it necessary to consider the additional administration of antibiotics in the case of fungal PJI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Periprosthetic Joint Infections Caused by Candida Species—A Single-Center Experience and Systematic Review of the Literature

Grzelecki

Grajek²,

Dudek

et al. 2022

JoF

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“…In general, authors have applied similar strategies used in bacterial PJIs, often favoring 2-stage revision. In a recent review, Gross et al summarized the results of 286 hip, knee, shoulder, and elbow fungal PJIs 5 . Two-stage revision was the most common (55%), with a success rate of 65%.…”

Section: Discussionmentioning

confidence: 99%

Two-Stage Revision Total Knee Arthroplasty for Chronic Histoplasma Capsulatum Prosthetic Joint Infection

Williams

Hogan

Damioli

2022

JBJS Case Connector

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Case: This report describes a histoplasma capsulatum total knee prosthetic joint infection (PJI) in an immunosuppressed patient treated with a 2-stage revision. The diagnosis of PJI was made based on minor criteria, and the causative organism was identified from cultures obtained at the time of explantation. The patient underwent induction with amphotericin B, followed by oral antifungal therapy and a successful 2-stage revision with a hinged prosthesis with an interval of ;7 months between stage 1 and stage 2. At the most recent follow-up (18 months), she remained clear from infection with planned lifetime antifungal suppression Conclusion: This case report highlights the importance of consideration of atypical organisms when treating immunocompromised patients. Furthermore, this case report documents one of the few cases of histoplasma PJI and provides a successful treatment algorithm to potentially be applied to future cases. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B921).

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“…Rates of PJI after total knee arthroplasty (TKA) range from 0.9% to 2% [2,3] and have been increasing in recent years [4e6]. The morbidity and economic burden attributable to the treatment of PJI is extensive [7], with oneyear mortality rates as high as 14% [8] and annual hospital costs for TKA PJI estimated to reach $1.85 billion by 2030 [9]. As such, identifying risks for poor outcomes and optimal treatment algorithms is of paramount importance, especially as we continue to move toward a value-based healthcare reimbursement system.…”

mentioning

confidence: 99%

Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes

Charalambous

Kim

Schwartz

et al. 2022

The Journal of Arthroplasty

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Fungal Periprosthetic Joint Infection: A Review of Demographics and Management

Cited by 38 publications

References 38 publications

Periprosthetic Joint Infections Caused by Candida Species—A Single-Center Experience and Systematic Review of the Literature

Periprosthetic Joint Infections Caused by Candida Species—A Single-Center Experience and Systematic Review of the Literature

Two-Stage Revision Total Knee Arthroplasty for Chronic Histoplasma Capsulatum Prosthetic Joint Infection

Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes

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