Microbiological, Clinical, and Surgical Features of Fungal Prosthetic Joint Infections: A Multi-Institutional Experience

Azzam, Khalid; Parvızı, Javad; Jungkind, Donald; Hanssen, Arlen D.; Fehring, Thomas K.; Springer, Bryan D.; Bozic, Kevin J.; Valle, Craig Della; Pulido, Luis; Barrack, Robert L.

doi:10.2106/jbjs.i.00574

Cited by 183 publications

(312 citation statements)

References 41 publications

(58 reference statements)

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“…These include patients with: malignant disease, drug therapies (antineoplastic, corticosteroids, immunosuppressive drugs), overuse of antibiotics, indwelling catheters, diabetes, TB, multiple revision surgery, reconstructions, and in IV drug users. 3 A high index of suspicion must, however, still be maintained in immunocompetent hosts. Fungal infections in immunocompetent hosts have been reported so do not just regard the specimen as being contaminated.…”

Section: Discussionmentioning

confidence: 99%

“…4 The organisms mostly involved are: Candida (albicans, parapsilosis, glabrata, tropicalis), Aspergillus, Coccidioides and Blastomycetes. 3,5 Candida albicans is the most common organism. 6 Fungal infections are prone to biofilm formation which makes treatment difficult as the drugs available do not all have good biofilm penetration.…”

Section: Discussionmentioning

confidence: 99%

“…Fever and a fistula are rare. 3,[9][10][11] The mean timespan between surgery and clinical signs is 21 months. …”

Section: Clinical Picturementioning

confidence: 99%

“…12 Prosthetic loosening is common. 3,10,11,13 A diagnostic error is often made by saying it is only a contaminant, whereas it might be the reason for the patient's symptoms. 9,10,11 Kuiper et al 10 had 51% of their original cultures reported as possible contaminants but in the end 21% of them were falsely reported as contaminants.…”

Section: Diagnosismentioning

confidence: 99%

“…3,9,11,14 Currently we rely on the results of cultures from joint aspirations or tissue. It can be intra-operative tissue specimens or aspirations.…”

Section: Diagnosismentioning

confidence: 99%

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Periprosthetic fungal infections: Be alert ( Clinical cases and review of the literature)

Botha¹,

Roux²,

McLoughlin³

2016

SA orthop. j.

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The increasing rate of arthroplasty, revisions and resistance to antibiotics has increased the risk for fungal infections. Fungal infections after joint replacements are rare but devastating. Different treatment modalities exist: suppressive therapy, debridement with retained prosthesis, Girdlestone procedures and 2-or even 3-stage revision arthroplasty. The aim of the review is to guide the surgeon with regard to a protocol to address fungal infections. AbstractThe increasing rate of arthroplasty, revisions and resistance to antibiotics has increased the risk for fungal infections. Different treatment modalities exist: suppressive therapy, debridement with retained prosthesis, Girdlestone procedures and 2-or even 3-stage revision arthroplasty. Fungal infections after joint replacements are rare but devastating. Purpose of the study:The aim was to see if there was any trend that could help with the diagnosis and management of patients with fungal infections. The literature was reviewed in order to assist with diagnosis and treatment. Materials and methods:A retrospective study was performed and all the cases seen and treated by a tumour and sepsis orthopaedic specialist from 1999 to 2015 were evaluated. Inclusion criteria: Patients had to be diagnosed with a fungal infection in any specimen which was sent for histology or culture. Exclusions: none.Results: Four patients were identified. All of them were males. Mean age 58 (35-71) years. The primary surgical indications were: vertebral osteomyelitis; post primary knee replacement; pig bite with lower limb sepsis and osteoarthritis knee, and a septic total hip replacement. Three cases cultured Candida parapsilosis and one Candida albicans of which three were tissue cultures and one a blood culture.Currently 75% have failed treatment -one passed away, one developed systemic sepsis, and one had an above-knee amputation and is still struggling with subsequent bacterial infections in the amputation stump. Conclusion:As long as there are higher incidences of fungal infections with devastating complications more evidence is needed. Numerous small case studies have been published, with the purpose of looking for the correct treatment: monotherapy, combination therapy, newer antifungals, higher dosages, implant retention or removal. It appears that the correct answer is unclear as yet.It is important to always have a high index of suspicion and good pre-operative planning together with a team approach: infectious diseases specialist, microbiologist and histologist. This approach will optimise the probability of making a diagnosis and to appropriately manage the fungus cultured.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Fever and a fistula are rare. 3,[9][10][11] The mean timespan between surgery and clinical signs is 21 months. …”

Section: Clinical Picturementioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

“…3,9,11,14 Currently we rely on the results of cultures from joint aspirations or tissue. It can be intra-operative tissue specimens or aspirations.…”

Section: Diagnosismentioning

confidence: 99%

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