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Updated: Mar 15, 2026
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report
Fernando Cobo1, Javier Rodríguez-Granger1, Enrique M López2
1a Department of Microbiology , Hospital Virgen de las Nieves , Granada , Spain.
Background:
The clinical and microbiological characteristics of prosthetic joint infection (PJI) caused by Candida species is described, including 72 cases in the literature and a case of Candida glabrata infection handled at the present centre.
Methods:
We describe one patient and using the key words 'fungal prosthetic joint infection' and 'candida prosthetic joint infection' we searched MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science, CINAHL and Cochrane systematic review databases for case reports of this condition.
Results:
Out of the 73 patients, 38 were female; mean age at diagnosis was 65.7 (± SD 18) yrs; 50 had risk factors for candidal infection such as systemic disease (e.g. rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus) and/or immunosuppressive therapy in 18 (24.6%) cases, diabetes mellitus in 14 (19.1%), immunosuppression due to malignant or chronic disease in 24 (32.8%) and long-term antibiotic use in four (5.4%) patients. Infection site was the knee in 36 patients and hip in 35; pain was present in 43 patients and swelling in 23 and the mean surgery-diagnosis interval was 32 months. The most frequent species was C. albicans, followed by C. parapsilosis. The diagnosis was obtained from joint fluid aspirate in 33 cases and intra-operative samples in 16. Susceptibility to antifungals was tested in only 21 isolates. The most frequently used antifungals were fluconazole and amphotericin B. Two-stage exchange arthroplasty was performed in 30 patients and resection arthroplasty in 31; 56 patients were cured with a combination of medical and surgical treatment; one patient died from the infection.
Conclusion:
PJI caused by Candida requires a high index of suspicion; surgery with long-term antifungal therapy is recommended.
Insights
Candida prosthetic joint infections (PJI) are rare but serious, often affecting older adults with risk factors. Early diagnosis and a combination of surgery with long-term antifungal treatment are crucial for successful outcomes.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Prosthetic joint infection (PJI) caused by Candida species presents unique clinical and microbiological challenges.
- This study analyzes 73 cases of PJI, including 72 from literature and one new case of Candida glabrata.
- Understanding the characteristics of fungal PJI is critical for timely diagnosis and effective management.
Observation:
- The majority of patients were female, with a mean age of 65.7 years.
- Common risk factors included systemic diseases, immunosuppressive therapy, diabetes mellitus, and prior antibiotic use.
- Knee and hip joints were most commonly affected, with pain and swelling as primary symptoms.
Findings:
- Candida albicans and Candida parapsilosis were the most frequently identified species.
- Diagnosis was primarily established through joint fluid aspirates and intra-operative samples.
- Treatment success was achieved in 56 patients through a combination of surgical intervention (two-stage exchange or resection arthroplasty) and antifungal therapy (fluconazole, amphotericin B).
Implications:
- PJI caused by Candida necessitates a high index of clinical suspicion.
- Combined surgical treatment and prolonged antifungal therapy are recommended for optimal patient outcomes.
- Further research into optimal antifungal strategies and risk factor mitigation for fungal PJI is warranted.
