Candida spondylodiscitis: a systematic review and meta-analysis of seventy two studies

Abstract

Objectives Knowledge of Candida spondylodiscitis is limited to case reports and smaller case series. Controversy remains on the most effective diagnostical and therapeutical steps once Candida is suspected. This systematic review summarized all cases of Candida spondylodiscitis reported to date concerning baseline demographics, symptoms, treatment, and prognostic factors. Methods A PRISMA-based search of PubMed, Web of Science, Embase, Scopus, and OVID Medline was performed from database inception to November 30, 2022. Reported cases of Candida spondylodiscitis were included regardless of Candida strain or spinal levels involved. Based on these criteria, 656 studies were analyzed and 72 included for analysis. Kaplan-Meier curves, Fisher’s exact, and Wilcoxon’s rank sum tests were performed. Results In total, 89 patients (67% males) treated for Candida spondylodiscitis were included. Median age was 61 years, 23% were immunocompromised, and 15% IV drug users. Median length of antifungal treatment was six months, and fluconazole (68%) most commonly used. Thirteen percent underwent debridement, 34% discectomy with and 21% without additional instrumentation. Median follow-up was 12 months. The two year survivorship free of death was 80%. The two year survivorship free of revision was 94%. Younger age (p = 0.042) and longer length of antifungal treatment (p = 0.061) were predictive of survival. Conclusion Most patients affected by Candida spondylodiscitis were males in their sixties, with one in four being immunocompromised. While one in five patients died within two years of diagnosis, younger age and prolonged antifungal treatment might play a protective role.

The IFSD Score—A Practical Prognostic Model for Invasive Fungal Spondylodiscitis

“…In total, 53 patients with a definite diagnosis of proven IFSD were retrospectively studied over 20 years. Except for the much higher overall one-year mortality rate (45.3%), the mean age (around 65) and male predominance were compatible with the studies previously reported [16,18,25,29]. Predisposing immunocompromised state was seen in about one-third of all the patients with IFSD involved and possessed one of the striking predictors for one-year mortality (50.0% vs. 17.2%, p = 0.011).…”

“…The overall mortality rate is around 20% [15,17]. Several risk factors for developing fungal spondylodiscitis were investigated, mainly related to immunocompromised states [16,18].…”

Salvage Therapy with Rezafungin for Candida parapsilosis Spondylodiscitis: A Case Report from Expanded Access Program

“…Candida spp. spondylodiscitis (CS) is a rare manifestation of invasive candidiasis; only 89 cases of culture-confirmed CS have been reported so far, according to a recent meta-analysis [3]. Candida albicans spondylodiscitis was the most frequent species isolated and only six cases of C. parapsilosis were described [3].…”

“…According to a meta-analysis by Adelhoefer and colleagues, among the 89 included patients with CS, antifungal monotherapy was given in 58% of cases; the most commonly used antifungal agents were fluconazole (68%), amphotericin B (38%), and echinocandins (26%), and the median length of antifungal treatment was six months [3]. Surgical intervention was performed in 68% of cases, including 34% undergoing instrumented discectomy [3]. At a median follow-up of 12 months, 3% developed sepsis, 6% underwent revision, and 12% died of disease [3].…”

“…Surgical intervention was performed in 68% of cases, including 34% undergoing instrumented discectomy [3]. At a median follow-up of 12 months, 3% developed sepsis, 6% underwent revision, and 12% died of disease [3]. Younger age (p = 0.042) and longer length of antifungal therapy (p = 0.061) were predictive of survival, whereas the outcome did not differ based on Candida strain (p = 0.74) and affected spinal level (p = 0.44) [3].…”