Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review

Abstract

Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

“…As a result of this, special attention must be given to specimen collection, as routine cultures may show no growth in the setting of a high clinical suggestion. To improve diagnostic yield, serial joint aspirations and multiple intraoperative specimens from diagnostic or therapeutic procedures are essential to help establish the causative organism [12, 13]. Fungal cultures should be plated on fungal selective media (for example, Sabourad dextrose) and growth can take up to 4 weeks [5].…”

“…Serologic markers including ESR and CRP were difficult to interpret in the context of severe RA. The previous and intermittent presence of CONS from aspirates and surgical specimens not only confounded organism-specific therapy but also significantly increased the patient’s baseline risk for a fungal PJI [12]. Initial suggestion of Aspergillus spp.…”

A rare case of Candida prosthetic joint infection: Diagnostic and therapeutic challenges in a resource poor country.

“…However, cases are reported increasingly due to rising number of joint arthroplasties worldwide. 1 Underlying immunocompromised status, systemic illness (diabetes mellitus), the use of antineoplastic agents, prolonged use of antibiotics and indwelling catheters are some of the risk factors for fungal PJI. 2 Despite this, nearly half the cases occur in patients without any identifiable risk factor 3 as in this patient.…”

“…However, she did not tolerate conventional amphotericin B deoxycholate for more than a week and it was decided to switch to anidulafungin based on the available literature. 1,4,5,7,8 As it was an expensive and restricted drug, there was a considerable delay in obtaining the drug during which the patient was not on any anti-fungal treatment. She succumbed to the infection three weeks after amphotericin was stopped.…”

“…1 It is commonly caused via direct inoculation of the organism or due to transient candidaemia, while underlying host immune suppression acts as the main predisposing factor. 2 Clinical recognition is often difficult due to its indolent onset and lack of other symptoms of infection during the initial stage.…”