Severe polymicrobial and fungal periprosthetic osteomyelitis persisting after hip disarticulations treated with caspofungin in risk patients: a case series

Abstract

Background Periprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome. Cases All the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control. Conclusion The polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.

Incidence and Risk Factors for Acid-fast Bacillus/Fungal Culture Positivity in Primary, Conversion, and Revision Hip and Knee Arthroplasty

“…The highest rate of success of infection eradication came from completion of two-stage revision supported by antifungal/AFB and/or antibacterial treatment. This parallels the evidence from previous studies that two-stage revision with appropriate systemic therapy continues to be recommended for fungal infection 27-30 and AFB infection. 31 The success in AFB treatment in this study, though in just one patient, supports the review conducted by Kim et al who noted the rarity of AFB PJI (namely, mycobacterium avium complex) and successful results with limited reinfection rates after two-stage revision and antibiotic therapy.…”

“…32 Given the variable nature of fungal infections, there are studies noting the need for long-term antifungal therapy to curb any future long-term risk. [27][28][29]32 Only one patient underwent a 3stage revision with notable success, which parallels the study produced by Baecker et al who noted an 89% success rate of infection resolution. 33 Despite the promising results, more studies should be done on the efficacy of 3-stage procedures for fungal PJI to determine its utility.…”

Fungal Periprosthetic Joint Infection Following Total Knee Arthroplasty as Easily Overlooked but the Most Dreaded Complication: Case Report and Systematic Review

“…The use of caspofungin reduces the ability of Candida to form bio lms and can penetrate them [110,111]. In mixed PJI, an abatement of the infection occurs only after caspofungin treatment [112]. Therefore, the bio lm penetration effect is particularly important for the successful treatment of mixed PJI.…”

Voriconazole Admixed with PMMA—Impact on Mechanical Properties and Efficacy

“…Fungal infections are generally associated with bacteria. They affect patients with decreased immunity, especially during revisions [6,7] with polymicrobial infections [8,9]. They are most frequently identified as yeasts (especially Candida spp.…”