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Updated: Aug 30, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Periprosthetic Joint Infections Caused by Candida Species-A Single-Center Experience and Systematic Review of the
Dariusz Grzelecki1, Aleksandra Grajek2, Piotr Dudek1
1Department of Orthopedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Professor Adam Gruca Orthopedic and Trauma Teaching Hospital, Konarskiego 13, 05-400 Otwock, Poland.
Background:
The aim of this study was to analyze the treatment results of fungal periprosthetic joint infections (PJI) caused by Candida species from a single orthopedic center and to compare them with reports from other institutions.
Methods:
Eight patients operated on from January 2014 to December 2021 met the inclusion criteria and were analyzed in terms of clinical outcomes. A systematic review of the literature identified 153 patients with Candida PJIs extracted from 12 studies according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines.
Results:
The success rate of the treatment in the case series was 50%. The most frequent pathogens were Candida albicans (three cases; 37.5%) and Candida parapsilosis (three cases; 37.5%). In one patient (12.5%), bacterial co-infection was noted, and in five patients (62.5%) significant risk factors of PJI were confirmed. The overall success rate on the basis of data collected for systematic review was 65.5%. A sub-analysis of 127 patients revealed statistically significant differences (p = 0.02) with a higher success rate for the knees (77.6%) than for the hips (58%). In 10 studies the analysis of risk factors was performed and among 106 patients in 77 (72.6%) comorbidities predispose to fungal PJI were confirmed. Bacterial co-infection was noted in 84 patients (54.9%). In 93 patients (60.7%) Candida albicans was the culprit pathogen, and in 39 patients (25.5%) Candida parapsilosis was the culprit pathogen. Based on these two most frequent Candida species causing PJI, the success rate of the treatment was statistically different (p = 0.03), and was 60.3% and 83.3%, respectively. The two-stage strategy was more favorable for patients with Candida parapsilosis infections (94.4% success rate) than the one-stage protocol (50% success rate; p = 0.02); as well as in comparison to the two-stage treatment of Candida albicans (65% success rate; p = 0.04).
Conclusions:
The analysis of the literature showed no differences in the overall success rate between one- and two-stage surgical strategies for all Candida species, but differed significantly comparing the two most frequent strains and concerning PJI localization. The frequent presence of bacterial co-infections makes it necessary to consider the additional administration of antibiotics in the case of fungal PJI.
Insights
Treatment success for fungal periprosthetic joint infections (PJI) varies by Candida species and joint location. Two-stage strategies show higher success for Candida parapsilosis PJI, and bacterial co-infections necessitate antibiotic consideration.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Mycology
Background:
- Fungal periprosthetic joint infections (PJI) are challenging complications following orthopedic procedures.
- Candida species are increasingly recognized as causative agents of PJI.
Purpose of the Study:
- To analyze treatment outcomes of Candida PJI at a single orthopedic center.
- To compare these outcomes with existing literature data.
Main Methods:
- Retrospective analysis of 8 patients with Candida PJI (2014-2021).
- Systematic literature review of 153 patients from 12 studies (PRISMA guidelines).
- Comparison of treatment strategies, pathogens, and risk factors.
Main Results:
- Single center: 50% success rate; Candida albicans and Candida parapsilosis were most frequent.
- Literature review: 65.5% overall success rate.
- Higher success for knee (77.6%) vs. hip (58%) PJI (p=0.02).
- C. parapsilosis PJI had higher success with two-stage (94.4%) vs. one-stage (50%) treatment (p=0.02).
- Bacterial co-infection present in 54.9% of reviewed cases.
Conclusions:
- Treatment success for Candida PJI depends on species and joint localization.
- Two-stage surgical strategy is more effective for Candida parapsilosis PJI.
- Bacterial co-infections are common and require consideration of adjunctive antibiotic therapy.
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