Candida periprosthetic joint infection: A rare and difficult-to-treat infection
| Autor: | Escolà-Vergé L, Rodríguez-Pardo D, Lora-Tamayo J, Morata L, Murillo O, Vilchez H, Sorli L, Carrión LG, Barbero JM, Palomino-Nicás J, Bahamonde A, Jover-Sáenz A, Benito N, Escudero R, Sampedro MF, Vidal RP, Gomez-Lopez L, Corona PS, Almirante B, Ariza J, Pigrau C, Study Group on Osteoarticular Infections of the Spanish Society of Clinical Micr |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Male medicine.medical_specialty Antifungal Agents Prosthesis-Related Infections Prosthesis Retention 2-stage treatment medicine.medical_treatment 030106 microbiology Antibiofilm agents Periprosthetic Disease Fungal periprosthetic infection Prosthesis 03 medical and health sciences Echinocandins 0302 clinical medicine Internal medicine medicine Humans Risk factor Aged Retrospective Studies Candida 030222 orthopedics Debridement business.industry Antifungal-loaded bone cement Candidiasis Retrospective cohort study Middle Aged Regimen Infectious Diseases Female business |
| Zdroj: | JOURNAL OF INFECTION r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu instname r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau Recercat. Dipósit de la Recerca de Catalunya r-FSJD: Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu Fundació Sant Joan de Déu |
| ISSN: | 0163-4453 |
| Popis: | Background: Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies. Methods: We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 in 16 Spanish hospitals. Results: Forty-three patients included: median age, 75 years, and median Charlson Comorbidity Index score, 4. Thirty-four (79.1%) patients had >= 1 risk factor for Candida infection. Most common causative species were C. albicans and C. parapsilosis. Thirty-five patients were evaluable for outcome: overall, treatment succeeded in 17 (48.6%) and failed in 18 (51.4%). Success was 13/20 (67%) in patients with prosthesis removal and 4/15 (27%) with debridement and prosthesis retention (p = 0.041). All 3 patients who received an amphotericin B-impregnated cement spacer cured. In the prosthesis removal group, success was 5/6 (83%) with an antibiofilm regimen and 8/13 (62%) with azoles (p = 0.605). In the debridement and prosthesis retention group, success was 3/10 (30%) with azoles and 1/5 (20%) with antibiofilm agents. Therapeutic failure was due to relapse in 9 patients, need for suppressive treatment in 5, persistent infection in 2, and CPJI-related death in 2; overall attributable mortality was 6%. Conclusions: CPJI is usually a chronic disease in patients with comorbidities and risk factors for Candida infection. Treatment success is low, and prosthesis removal improves outcome. Although there is insufficient evidence that use of antifungals with antibiofilm activity has additional benefits, our experience indicates it may be recommendable. (C) 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved. |
| Databáze: | OpenAIRE |
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