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

• Published in: Infectious diseases and therapy Vol. 13; no. 5; pp. 1051 - 1065
• Main Authors: Starnes, Victoria, Duggan, Joan, Hollingshead, Caitlyn
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-05-2024; Springer; Springer Nature B.V; Adis, Springer Healthcare
• Subjects: Antifungal agents; Care and treatment; Clinical outcomes; Fungal; Health aspects; Implants, Artificial; Infection; Infections; Infectious Diseases; Internal Medicine; Literature reviews; Medical research; Medical treatment; Medicine; Medicine & Public Health; Medicine, Experimental; Microbiology; Original Research; Orthopedic infections; Prostheses; Prosthesis; Prosthetic joint infection; Fungal; Prosthetic joint infection; Orthopedic infections
• ISSN: 2193-8229; 2193-6382
• DOI: 10.1007/s40121-024-00964-9

Introduction
Fungal prosthetic joint infections comprise less than 1% of prosthetic joint infections. Thus, little is known regarding optimal management. This study aims to characterize the microbiology, surgical and medical management, and outcomes for these complex infections. The objectives of this study were to assess the impact of surgical approach, antifungal treatment, fungal species, and time to onset of infection from initial surgery on patient outcomes.
Methods
A retrospective record review over 12 years was performed in two health systems that included patients with a deep culture positive for a fungal isolate and the presence of a prosthetic joint. A literature review was performed using the same inclusion criteria. A total of 289 cases were identified and analyzed.
Results
Candida
was the most common isolate, and a two-stage revision was the most commonly employed surgical modality
.
The type of surgical intervention had a statistically significant relationship with outcome (
P
 = 0.022).
Conclusions
Two-stage revision with extended antifungal therapy is preferred in these infections due to higher rates of positive outcomes.
Plain Language Summary
Prosthetic joint infections may be caused by fungal organisms, but as this is rare, it is not known how to best treat these infections. This study explores the types of fungal organisms involved in these infections, options for surgical and medical treatment, and patient outcomes. We analyzed records over 12 years at two health systems and the currently published works on this topic. A total of 289 records were analyzed. The fungus
Candida
was the most common infectious cause, and a two-stage revision surgery was most commonly performed. We found that the type of surgical intervention was correlated with the patient outcome and that two-stage revision with a long course of antifungal medications is preferred in these infections.