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Updated: Nov 6, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
A spacer infection by Candida albicans secondary to a Staphylococcus capitis prosthetic joint infection: a case
Marta Bottagisio1, Alessandro Bidossi2, Nicola Logoluso3
1IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Via R. Galeazzi 4, 20161, Milan, Italy. marta.bottagisio@grupposandonato.it.
Background:
Prosthetic joint infection (PJI) is one of the most feared complications following total arthroplasty surgeries. Gram-positive bacteria are the most common microorganisms implicated in PJIs, while infections mediated by fungi only account for 1% of cases. When dealing with PJIs, a two-stage revision arthroplasty is widely used. Briefly, a spacer is introduced until re-implantation of the definitive prosthesis to provide skeleton stabilization while delivering antibiotics in the site of the infection. Sometimes, antimicrobial therapy may fail, but the isolation of a second microorganism from the spacer is uncommon and even less frequent that of a yeast.
Case Presentation:
Here is described a case of a 75-year-old woman who underwent two-stage revision surgery of the left hip prosthesis secondary to a Staphylococcus capitis infection, whose spacer was found to be infected by Candida albicans at a later time. Briefly, the patient underwent revision surgery of the hip prosthesis for a suspected PJI. After the debridement of the infected tissue, an antibiotic-loaded spacer was implanted. The microbiological analysis of the periprosthetic tissues and the implant depicted a S. capitis infection that was treated according to the antimicrobial susceptibility profile of the clinical isolate. Three months later, the patient was admitted to the emergency room due to local inflammatory signs. Synovial fluid was sent to the laboratory for culture. No evidence of S. capitis was detected, however, a yeast was identified as Candida albicans. Fifteen days later, the patient was hospitalized for the removal of the infected spacer. Microbiological cultures confirmed the results of the synovial fluid analysis. According to the susceptibility profile, the patient was treated with fluconazole (400 mg/day) for 6 months. Seven months later, the patient underwent second-stage surgery. The microbiological tests on the spacer were all negative. After 12 months of follow-up, the patient has fully recovered and no radiological signs of infection have been detected.
Conclusions:
Given the exceptionality of this complication, it is important to report these events to better understand the clinical outcomes after the selected therapeutic options to prevent and forestall the development of either bacterial or fungal spacer infections.
Insights
A rare case of prosthetic joint infection (PJI) involving Candida albicans in a hip spacer after Staphylococcus capitis treatment highlights the need for vigilance. This fungal superinfection required specific antifungal therapy, emphasizing careful monitoring post-revision arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Prosthetic joint infection (PJI) is a severe complication of total arthroplasty, typically caused by Gram-positive bacteria.
- Fungal infections are rare causes of PJI, accounting for only 1% of cases.
- Two-stage revision arthroplasty with an antibiotic-loaded spacer is a common treatment for PJI.
Observation:
- A 75-year-old woman with a history of Staphylococcus capitis PJI developed a subsequent infection of her antibiotic-loaded hip spacer by Candida albicans.
- Initial treatment targeted S. capitis, but a later diagnosis of fungal superinfection was made based on synovial fluid cultures.
- The patient required removal of the infected spacer and a course of fluconazole for the Candida albicans infection.
Findings:
- The case demonstrates an uncommon scenario of a yeast infection developing in a spacer previously used for bacterial PJI.
- Successful treatment involved antifungal therapy and a second-stage revision surgery.
- The patient achieved full recovery with no signs of infection after 12 months of follow-up.
Implications:
- This case underscores the importance of considering fungal superinfections in persistent or recurrent PJIs, even after initial bacterial treatment.
- Reporting such exceptional complications aids in understanding clinical outcomes and refining therapeutic strategies for both bacterial and fungal spacer infections.
- Vigilant microbiological monitoring is crucial during two-stage revision arthroplasty to detect secondary or opportunistic infections.
