Candida periprosthetic joint infections — risk factors and outcome between albicans and non-albicans strains

Abstract

Background Despite its scarcity, fungal periprosthetic joint infection (PJI) is of great clinical relevance as diagnosis and treatment are highly challenging. Previous analyses focused on the treatment rather than the role of the causative fungal agent on clinical outcome. This is the largest study of its kind to evaluate Candida strain–dependent differences in patients with fungal PJI. Methods We retrospectively analyzed 29 patients who underwent surgical intervention due to Candida hip or knee PJI in our department from 2010 to 2018. PJI was defined according to IDSA, recurrent PJI according to modified Delphi consensus criteria. Statistical analysis was performed using t-test, chi-square test with Yates correction, and log rank test. Results Besides age and affected joint, no significant differences were found between Candida albicans and non-albicans PJI patients (75.83 versus 64.11 years, p = 0.012; 12 hip versus two knee cases, p = 0.013). Most patients received two- (27.59%) or three-stage exchange surgery (41.38%). There was a statistical trend towards an increase in surgery needed in non-albicans Candida PJI (2.92 versus 2.12; p = 0.103). After initial Candida PJI treatment, functional prosthesis implantation was achieved in 72.41% of all patients. At last follow-up, infection-free survival was at 26.79% in Candida albicans versus 72.00% in non-albicans PJI (p = 0.046). Conclusions In this study, we found infection-free survival rates to be significantly decreased in patients with albicans compared to non-albicans Candida PJI. While age and affected joint might play a confounding role, we speculate the causative pathogen to play a decisive role in disease progression.

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

“…However, the two-stage protocol was statistically more effective for Candida parapsilosis PJI in comparison to the one-stage protocol ( p = 0.02) and in comparison to the two-stage treatment results of Candida albicans ( p = 0.4). Similar results were received by Karczewski et al, who compared albicans and non-albicans strains causing PJIs [ 24 ]. They reported an 80% of success rate for the non-albicans and 56.3% for albicans PJIs.…”

“…A total of 12 studies comprising 153 cases of Candida PJI were included in the final analysis ( Table 2 ) [ 12 , 21 , 22 , 23 , 24 , 25 , 26 , 32 , 33 , 34 , 35 , 36 ]. The number of hip-to-knee PJI was 86 (54.8%) to 67 (46.2%), respectively.…”

“…However, one-stage surgical strategies are also performed with good results in different orthopedic centers [ 21 , 22 ]. Recently, several valuable studies concerning Candida PJIs were published [ 12 , 23 , 24 , 25 , 26 ] but not included in currently available systematic reviews [ 17 , 27 ].…”

Serum and Synovial Markers in Patients with Rheumatoid Arthritis and Periprosthetic Joint Infection

“…In our study, we found prosthesis failure rates after revision arthroplasty to be significantly elevated in patients with rheumatoid arthritis, further stressing the need for a more personalized diagnostic and therapeutic approach in these patients. Similarly, prosthesis survival rates after revision arthroplasty have been found to be significantly decreased in non-rheumatoid arthritis patients [ 11 , 12 , 33 ].…”

Perspective Chapter: Hydroxyapatite – Surface Functionalization to Prevent Bacterial Colonization

“…Fungal infections of implants are rare events, but their treatment involves more medical problems and aggressive surgical treatments than normal bacterial infections. Most fungal infections are caused by candida species, such as Candida albicans and Candida parapsilosis [28,29].…”