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Fungal Prosthetic Joint Infection: A Case Series and Review of the Literature

Victoria Starnes1, Joan Duggan2, Caitlyn Hollingshead3

  • 1The University of Toledo College of Medicine and Life Sciences, Toledo, USA.

Infectious Diseases and Therapy
|April 13, 2024
PubMed
Abstract

Insights

Fungal prosthetic joint infections are rare but challenging. Optimal management involves a two-stage revision surgery with extended antifungal therapy for better patient outcomes.

Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Mycology

Background:

  • Fungal prosthetic joint infections (PJIs) are uncommon, representing less than 1% of all PJIs.
  • Limited data exists on the optimal management strategies for these complex infections.

Purpose of the Study:

  • To characterize the microbiology, surgical and medical management, and outcomes of fungal PJIs.
  • To assess the impact of surgical approach, antifungal treatment, fungal species, and time to infection onset on patient outcomes.

Main Methods:

  • Retrospective record review of patients with fungal PJIs across two health systems over 12 years.
  • Inclusion of patients with deep culture-positive fungal isolates and prosthetic joints.
  • Literature review using the same inclusion criteria, analyzing a total of 289 cases.

Main Results:

  • Candida species were the most frequent fungal isolates identified.
  • Two-stage revision surgery was the most common surgical approach employed.
  • A statistically significant relationship was observed between the type of surgical intervention and patient outcomes (P=0.022).

Conclusions:

  • Two-stage revision surgery is the preferred surgical modality for fungal PJIs.
  • Extended antifungal therapy, in conjunction with two-stage revision, is associated with higher rates of positive outcomes.
Keywords:
FungalOrthopedic infectionsProsthetic joint infection

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