Outcome Predictors of Candida Prosthetic Joint Infections: A Systematic Review and Meta-analysis

Candida prosthetic joint infections (CPJI) are serious complications, for which optimal surgical management and antifungal therapy remain unclear. This systematic review and meta-analysis aimed at defining the outcome predictors of CPJI.

A systematic literature review was performed in PubMed, Medline, Embase, and Web of Science until July 2024. Articles (cohorts, case-series or case reports) reporting individual data of adult patients with CPJI were included. Data about underlying conditions, characteristics of infection, and outcomes were collected. Outcome predictors were assessed in univariate analysis. Significant variables were included in a multivariate model using logistic regression with a binomial link function. Multicollinearity among the independent variables was assessed using the variance inflation factor.

A total of 385 CPJI (including 204 hip and 152 knee infections) from 110 publications were included. Polymicrobial infections accounted for 33% cases. Candida albicans (47.2%) was the predominant species followed by Candida parapsilosis (28.6%). In multivariate analysis, independent predictors of failure were co-infection with Staphylococcus aureus (odds ratio, 0.4; 95% confidence interval, 0.18-0.92; P = .032) and debridement/retention of the prosthesis (0.25; 0.11-0.55; P < .001), whereas first-line therapy with amphotericin B was associated with success (3.18; 1.25-9.87; P = .014). No difference according to the type of prosthesis exchange procedure (1, 2, or 3 stages) was found. Use of local antifungal therapy (eg, antifungal drug-impregnated spacers) had no significant impact on outcome.

This study confirms the importance of complete hardware removal in CPJI. Most importantly, it provides evidence supporting the use of amphotericin B as initial antifungal therapy.