Risk Factors for Fungal Prosthetic Joint Infection

Abstract

Background: Fungal prosthetic joint infections (PJIs) are rare and often associated with poor outcome; however, risk factors are not well described. Methods: This was a retrospective case control study among all patients with PJIs from 2006-2016 at two major academic centers. Each fungal PJI case was matched 1:1 with a bacterial PJI control by joint (hip, knee, shoulder) and year of diagnosis. We compared demographics, comorbidities, and clinical characteristics between cases and controls using chi square/Fisher's exact or Wilcoxon rank sum test. Independent risk factors were identified with multivariable logistic regression. Results: Forty-one fungal PJIs occurred over the study and 61% were due to Candida albicans. The hip was involved in 51.2% of cases, followed by the knee (46.3%). Compared to bacterial PJI, fungal PJI cases were more likely to have received antibiotics within the previous 3 months (70.7% vs 34%, P=.001), wound drainage lasting >5 days (48% vs 9%, P=.0002), had a lower median CRP (2.95 mg/dl vs 5.99, P=.013) and synovial fluid white blood cell count (13,953 cells/mm 3 vs 33,198, P=.007), and a higher proportion of prior two-stage exchanges (82.9% vs 53.6%, P=.008). After controlling for center, prolonged wound drainage (OR, 7.3; 95% CI,) and recent antibiotics (OR, 3.4; 95% CI, 1.2-9.3) were significantly associated with fungal PJI. Conclusion: In our study, Candida albicans was the most common species in fungal PJIs and prolonged wound drainage and recent antibiotics were independent risk factors. These clinical characteristics may help providers anticipate fungal PJI and adjust management strategies.

Candida Periprosthetic Joint Infection: Is It Curable?

“…Other species, such as C. glabrata and C. tropicalis, were more anecdotic (3–7% and 2–4%, respectively). Smaller series have found similar results [ 13 , 14 ], and in a recent review of the literature, C. albicans (47.3%) was the most frequent strain isolated, followed by C. parapsilosis (22.3%) [ 15 ], but epidemiology may still vary among regions.…”

“…(3) Immunosuppression secondary to malignant diseases, immunodeficiencies, or immunosuppressive therapy. Other risk factors reported in patients with CPJIs have been older age [ 18 ], diabetes, rheumatoid arthritis, malnutrition, and tuberculosis, which probably also reflect alterations in host immunity [ 2 , 12 , 13 , 14 , 23 ]. Other series have also identified that multiple previous surgeries at the site of the CPJI are also a risk factor [ 2 , 13 , 23 , 24 ].…”

A spacer infection by Candida albicans secondary to a Staphylococcus capitis prosthetic joint infection: a case report

“…C. parapsilosis , C. tropicalis , and C. glabrata ) [ 9 ]. As reported in the literature, the incidence of C. albicans -mediated PJIs is around 1% [ 2 ].…”

“…The presence of a foreign body is the triggering event for infections, because it permits the attachment of microorganisms and biofilm formation, making the eradication of the infection difficult [ 1 ]. Gram-positive bacteria are the most common microorganisms implicated in PJIs, while infections mediated by fungi only account for 1% of cases in which Candida albicans is the leading organism [ 2 ]. When dealing with PJIs, a two-stage revision arthroplasty is widely used.…”

Candidal periprosthetic joint infection after primary total knee arthroplasty combined with ipsilateral intertrochanteric fracture: A case report

“…Patients who are immunocompromised, have an underlying systemic illness or have been subject to prolonged antibiotic regimens may have a higher risk of fungal infection. Prolonged wound drainage has also recently been identified as a potential risk factor[ 7 ]. The most likely cause of fungal infection in the reported case is the extensive use of antibiotics before identifying a definitve cause of the prosthetic joint infection.…”