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Prosthetic Joint Infections due to Candida Species: A Multicenter International Study
Aurélien Dinh1, Martin McNally2, Emma D'Anglejan1
1Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches, France.
Background:
Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI.
Methods:
This was a retrospective observational multinational study including patients diagnosed with Candida-related PJI between 2010 and 2021. Treatment outcome was assessed at 2-year follow-up.
Results:
A total of 269 patients were analyzed. Median age was 73.0 (interquartile range [IQR], 64.0-79.0) years; 46.5% of patients were male and 10.8% were immunosuppressed. Main infection sites were hip (53.0%) and knee (43.1%), and 33.8% patients had fistulas. Surgical procedures included debridement, antibiotics, and implant retention (DAIR) (35.7%), 1-stage exchange (28.3%), and 2-stage exchange (29.0%). Candida spp identified were Candida albicans (55.8%), Candida parapsilosis (29.4%), Candida glabrata (7.8%), and Candida tropicalis (5.6%). Coinfection with bacteria was found in 51.3% of cases. The primary antifungal agents prescribed were azoles (75.8%) and echinocandins (30.9%), administered for a median of 92.0 (IQR, 54.5-181.3) days. Cure was observed in 156 of 269 (58.0%) cases. Treatment failure was associated with age >70 years (OR, 1.811 [95% confidence interval {CI}: 1.079-3.072]), and the use of DAIR (OR, 1.946 [95% CI: 1.157-3.285]). Candida parapsilosis infection was associated with better outcome (OR, 0.546 [95% CI: .305-.958]). Cure rates were significantly different between DAIR versus 1-stage exchange (46.9% vs 67.1%, P = .008) and DAIR versus 2-stage exchange (46.9% vs 69.2%, P = .003), but there was no difference comparing 1- to 2-stage exchanges (P = .777).
Conclusions:
Candida PJI prognosis seems poor, with high rate of failure, which does not appear to be linked to immunosuppression, use of azoles, or treatment duration.
Insights
Candida prosthetic joint infections (PJI) have a poor prognosis, with a high failure rate. Treatment success is not linked to immunosuppression or antifungal duration, but surgical approach impacts outcomes.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Mycology
Background:
- Prosthetic joint infection (PJI) caused by Candida species is a serious complication following arthroplasty.
- Investigating the outcomes of Candida PJI is crucial for improving patient management.
Purpose of the Study:
- To analyze the treatment outcomes of patients diagnosed with Candida-related PJI.
- To identify factors associated with treatment success or failure in Candida PJI.
Main Methods:
- Retrospective, multinational observational study of patients with Candida PJI from 2010-2021.
- Assessment of treatment outcomes at a 2-year follow-up.
- Analysis of patient demographics, infection sites, surgical procedures, causative Candida species, and antifungal treatments.
Main Results:
- A total of 269 patients were analyzed; 58.0% achieved cure.
- Treatment failure was associated with age >70 years and debridement, antibiotics, and implant retention (DAIR) procedures.
- Candida parapsilosis infection showed a better outcome, while DAIR had lower cure rates compared to 1-stage and 2-stage exchanges.
Conclusions:
- Candida PJI has a generally poor prognosis with a high failure rate.
- Factors like age and surgical strategy significantly influence treatment outcomes.
- Immunosuppression, azole use, and treatment duration did not appear to be linked to failure.
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