Staged Reimplantation of a Total Hip Prosthesis After Co-infection with Candida tropicalis and Staphylococcus haemolyticus: A Case Report

Sebastian, Sujeesh; Malhotra, Rajesh; Pande, Ashish; Gautam, Deepak; Xess, Immaculata; Dhawan, Benu

doi:10.1007/s11046-017-0177-x

Cited by 14 publications

(6 citation statements)

References 17 publications

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“…A total of 89 patients (45; 50.6% males) suffering fungal PJI occurring in the hip joint, covering a 22-year period, were identified [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 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 ]. The studied population’s mean age was 66.9 years (standard deviation (SD) = 13.2).…”

Section: Resultsmentioning

confidence: 99%

Fungal Periprosthetic Hip Joint Infections

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

Fungal Periprosthetic Hip Joint Infections

et al. 2022

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“…As reported,2627 the association of Salmonella typhimurium and Burkholderia cenocepacia with PJI further extends the clinical spectrum of these pathogens. Although PJI caused by Candida is rare; nonetheless, it should be considered in symptomatic and immunocompromised patients with a joint prosthesis 28…”

Section: Discussionmentioning

confidence: 99%

A Clinico-Microbiological Study of Prosthetic Joint Infections in an Indian Tertiary Care Hospital: Role of Universal 16S rRNA Gene Polymerase Chain Reaction and Sequencing in Diagnosis

Sebastian

Malhotra

Sreenivas

et al. 2019

IJOO

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Background: We determined the magnitude and clinico-microbiological profile of prosthetic joint infection (PJI) at a tertiary hospital. The diagnostic potential of 16S rRNA gene polymerase chain reaction (PCR) and sequencing on periprosthetic tissue samples was evaluated for the diagnosis of PJI. Materials and Methods: This ambispective cohort study consisted of patients who underwent primary or revision hip or knee arthroplasty from June 2013 to June 2017. The patients were classified as either infected or noninfected according to criteria set out by the musculoskeletal infection society (MSIS). Three to five periprosthetic tissue samples were collected from each patient for culture and 16S rRNA gene PCR sequencing. Results: Hundred and six patients were diagnosed to have PJI as per the MSIS Criteria. The cumulative incidence of PJI at our Institute at the end of 36 months was 1.1% (95% confidence interval [CI]: 0.59–2.91). Microorganisms were isolated by periprosthetic tissue culture (PTC) in 84 patients (sensitivity: 79% and specificity: 100%). Gram-negative aerobes were most frequently isolated (61%). Polymicrobial infections were present in 8.3% of cases. The most common infecting microorganism was Staphylococcus aureus (19.5%). Multidrug resistance and methicillin resistance were noted in 54% and 34% of bacterial isolates, respectively. The sensitivity and specificity of 16S rRNA PCR of periprosthetic tissue was 86% (95% CI: 74.9–89.9) and 100% (95% CI: 94.7–100), respectively. Periprosthetic tissue 16S rRNA PCR was more sensitive than PTC ( P = 0.008), although both were 100% specific ( P = 0.99). Conclusions: The incidence of PJI at our Institute compares well with other published reports. Contrary to previous reports, a predominance of Gram-negative PJI's was found. The preponderance of multidrug-resistant organisms in PJI's is worrisome. The high sensitivity and specificity of the 16S PCR assay used in our study support its use in culture-negative PJI suspected cases.

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“…However, amphotericin B has many side effects and may not be useful for long-term therapy. On the other hand, voriconazole has good synovial fluid penetration and excellent bioavailability and is less nephrotoxic than amphotericin B [32]. Although recently in vitro study showed good elution of voriconazole from PMMA, compressive strength of the cement progressively decreases with elution.…”

Section: Discussionmentioning

confidence: 99%

Candida glabrata-Induced Refractory Infectious Arthritis: A Case Report and Literature Review

Chen

Zhou

et al. 2019

Mycopathologia

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The incidence of deep fungal infection due to non-albicans Candida species (especially Candida glabrata) has significantly increased in recent decades. Candida glabrata is an opportunistic pathogen of low virulence which mainly invades the gastrointestinal, genitourinary, and respiratory tracts, but has rarely been reported as complication of articular surgery in the literature. We present a case of knee fungal arthritis caused by C. glabrata after a minimally invasive arthroscopic surgery. In this case, the patient's knee got infected after arthroscopic treatment for a recurrent popliteal cyst, and she was unable to be cured by either debridement or antifungal drugs. Mycological and molecular identification of the necrotic tissues isolate revealed C. glabrata as etiologic agent. We originally planned to conduct a debridement once again, but it was found that the articular cartilage was extensively damaged during the operation. Besides, the magnetic resonance imaging of the affected knee also showed that the infection had invaded the subchondral bone. So we treated this case with a two-stage primary total knee arthroplasty with an antibiotic-laden cement spacer block. After a 10-month follow-up, the patient had completely recovered and has not experienced any recurrence to date. In addition, we review 21 cases of C. glabratainduced infectious arthritis described to date in the literature.

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Staged Reimplantation of a Total Hip Prosthesis After Co-infection with Candida tropicalis and Staphylococcus haemolyticus: A Case Report

Cited by 14 publications

References 17 publications

Fungal Periprosthetic Hip Joint Infections

Fungal Periprosthetic Hip Joint Infections

A Clinico-Microbiological Study of Prosthetic Joint Infections in an Indian Tertiary Care Hospital: Role of Universal 16S rRNA Gene Polymerase Chain Reaction and Sequencing in Diagnosis

Candida glabrata-Induced Refractory Infectious Arthritis: A Case Report and Literature Review

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