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Updated: Oct 13, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Candida periprosthetic joint infections - risk factors and outcome between albicans and non-albicans strains
Daniel Karczewski1, Yi Ren1, Octavian Andronic2
1Center for Musculoskeletal Surgery, Clinic for Orthopedics, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany.
Background:
Despite its scarcity, fungal periprosthetic joint infection (PJI) is of great clinical relevance as diagnosis and treatment are highly challenging. Previous analyses focused on the treatment rather than the role of the causative fungal agent on clinical outcome. This is the largest study of its kind to evaluate Candida strain-dependent differences in patients with fungal PJI.
Methods:
We retrospectively analyzed 29 patients who underwent surgical intervention due to Candida hip or knee PJI in our department from 2010 to 2018. PJI was defined according to IDSA, recurrent PJI according to modified Delphi consensus criteria. Statistical analysis was performed using t-test, chi-square test with Yates correction, and log rank test.
Results:
Besides age and affected joint, no significant differences were found between Candida albicans and non-albicans PJI patients (75.83 versus 64.11 years, p = 0.012; 12 hip versus two knee cases, p = 0.013). Most patients received two- (27.59%) or three-stage exchange surgery (41.38%). There was a statistical trend towards an increase in surgery needed in non-albicans Candida PJI (2.92 versus 2.12; p = 0.103). After initial Candida PJI treatment, functional prosthesis implantation was achieved in 72.41% of all patients. At last follow-up, infection-free survival was at 26.79% in Candida albicans versus 72.00% in non-albicans PJI (p = 0.046).
Conclusions:
In this study, we found infection-free survival rates to be significantly decreased in patients with albicans compared to non-albicans Candida PJI. While age and affected joint might play a confounding role, we speculate the causative pathogen to play a decisive role in disease progression.
Insights
Fungal periprosthetic joint infection (PJI) outcomes differ by Candida species. Candida albicans PJI patients had significantly lower infection-free survival rates compared to non-albicans Candida PJI patients.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Mycology
Background:
- Fungal periprosthetic joint infection (PJI) presents diagnostic and treatment challenges.
- Previous research has not fully explored the impact of specific fungal agents on PJI outcomes.
- This study is the largest to date investigating Candida strain-specific differences in PJI.
Purpose of the Study:
- To evaluate the differences in clinical outcomes between Candida albicans and non-albicans periprosthetic joint infections.
- To analyze the impact of the causative Candida species on disease progression and treatment success.
- To identify factors influencing infection-free survival in patients with fungal PJI.
Main Methods:
- Retrospective analysis of 29 patients with Candida hip or knee PJI (2010-2018).
- PJI and recurrent PJI defined by IDSA and modified Delphi criteria, respectively.
- Statistical analysis included t-tests, chi-square tests with Yates correction, and log rank tests.
Main Results:
- No significant differences between Candida albicans and non-albicans PJI patients regarding age and affected joint.
- Higher rates of two- or three-stage exchange surgery were observed.
- Infection-free survival was significantly lower for Candida albicans (26.79%) compared to non-albicans Candida PJI (72.00%).
Conclusions:
- Candida species significantly impacts infection-free survival in PJI patients.
- Patients with Candida albicans PJI exhibit poorer outcomes than those with non-albicans Candida PJI.
- The causative fungal pathogen plays a critical role in PJI disease progression.
