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[Candida infection in hip alloarthroplasty]
K L Prenzel1, J Isenberg, H J Helling
1Klinik für Unfall-, Hand- und Wiederherstellungschirurgie,Klinikum der Universität zu Köln, Cologne.
Der Unfallchirurg
|January 29, 2003
Summary
A challenging hip replacement infection involving multiple pathogens was successfully treated with antifungal therapy and a staged revision approach. This case highlights effective management of complex prosthetic joint infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Necrosis of the femoral head necessitates total hip replacement (THR).
- Patients with polytoxicomania, diabetes, and polyneuropathy present complex comorbidities.
- Prosthetic joint infections (PJIs) are a significant complication following THR.
Observation:
- A 46-year-old polytoxicomanic patient developed a deep wound infection post-THR, initially involving Staphylococcus aureus, Enterococcus, and Candida parapsilosis.
- Despite multiple revision surgeries, antibiotics, and drainage, the infection persisted.
- Subsequent cultures after prosthesis removal and PMMA spacer insertion revealed Candida albicans.
Findings:
- Antifungal therapy with fluconazole eradicated Candida albicans infection.
- A staged revision involving a temporary spacer and subsequent prosthesis reimplantation was successful.
- The patient remained infection-free at the final follow-up.
Implications:
- This case demonstrates the successful management of a polymicrobial prosthetic joint infection with a specific focus on fungal eradication.
- Staged revision arthroplasty with appropriate antimicrobial therapy is a viable strategy for complex PJIs.
- The importance of thorough microbiological investigation and tailored treatment in recalcitrant infections is emphasized.