Prosthetic Joint Infections due to Candida Species: A Multicenter International Study
Author:
Dinh Aurélien1ORCID, McNally Martin2, D’Anglejan Emma1, Mamona Kilu Christel1, Lourtet Julie3, Ho Rosemary2, Scarborough Matthew2, Dudareva Maria2, Jesuthasan Gerald2, Ronde Oustau Cecile4, Klein Stéphane4, Escolà-Vergé Laura5, Rodriguez Pardo Dolores5, Delobel Pierre6, Lora-Tamayo Jaime7, Mancheño-Losa Mikel7, Sorlí Redó Maria Luisa8, Barbero Allende José María9, Arvieux Cédric10, Vaznaisiène Danguole11, Bauer Thomas12, Roux Anne-Laure13, Noussair Latifa13, Corvec Stéphane14, Fernández-Sampedro Marta15, Rossi Nicolò16, Lemaignen Adrien17, Costa Salles Mauro José18, Cunha Ribeiro Taiana18, Mazet Julien19, Sasso Milène19, Lavigne Jean-Philippe19, Sotto Albert19, Canouï Etienne20, Senneville Éric21, Thill Pauline21, Lortholary Olivier2223, Lanternier Fanny2223, Morata Laura24, Soriano Alex24, Giordano Gérard25, Fourcade Camille26, Franck Bernhard J H27, Hofstätter Jochen G27, Duran Clara1, Bonnet Eric26, , Bauer Thomas, Courboulès Camille, d’Anglejan Emma, Dinh Aurélien, Duran Clara, Kilu Christel Mamona, Noussair Latifa, Roux Anne-Laure, Bonnet Eric, Fourcade Camille, Giordano Gérard, Dudareva Maria, Ho Rosemary, Jesuthasan Gerald, McNally Martin, Scarborough Matthew, Frank Bernhard J H, Hofstätter Jochen G, Klein Stephane, Oustau Cecile Ronde, Senneville Éric, Thill Pauline, Escolà-Vergé Laura, Pardo Dolores Rodriguez, Morata Laura, Soriano Alex, Canouï Etienne, Paugam André, Touanga Gertrude, Delobel Pierre, Lora-Tamayo Jaime, Mancheño-Losa Mikel, Lavigne Jean-Philippe, Sasso Milène, Mazet Julien, Sotto Albert, Junyent Juan Gomez, Redó Maria Luisa Sorlí, Costa Salles Mauro José, Ribeiro Taiana Cunha, Allende José Maria Barbero, Desoubeaux Guillaume, Lemaignen Adrien, Porche Chloé, Arvieux Cédric, Méheut Anne, Gangneux Jean-Pierre, Couzigou Carine, Lourtet Julie, Pilmis Benoît, Stucinskas Justinas, Vaznaisiene Danguole, Rossi Nicolò, Corvec Stéphane, Crenn Vincent, Morio Florent, Fernández-Sampedro Marta, Lanternier Fanny, Lortholary Olivier
Affiliation:
1. Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris , Garches , France 2. Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals , Oxford , United Kingdom 3. Clinical Microbiology Laboratory, Saint-Joseph Hospital , Paris 4. Orthopedic Surgery Department, Strasbourg University Hospital , Strasbourg , France 5. Infectious Disease Department, Vall d’Hebron University Hospital , Barcelona , Spain 6. Infectious Disease Department, Toulouse University Hospital , Toulouse , France 7. Internal Medicine Department, Hospital Universitario 12 de Octubre , Madrid 8. Infectious Disease Department, Hospital del Mar , Barcelona 9. Internal Medicine Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares , Madrid , Spain 10. Infectious Disease Department, Rennes University Hospital , Rennes , France 11. Infectious Disease Department, Lithuanian University of Health Sciences , Kaunas , Lithuania 12. Orthopedic Surgery Department 13. Microbiology Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris , Garches 14. Infectious Disease Department, Nantes University Hospital , Nantes , France 15. Internal Medicine Department, Marques de Valdecilla Hospital, Instituto de Investigación Sanitaria Valdecilla (IDIVAL) , Centro De Investigación Biomédica En Red Enfermedades Infecciosas (CIBERINFEC), Santander , Spain 16. Orthopedic Surgery Department, Sant’Orsola Polyclinic , Bologna , Italy 17. Infectious Disease Department, Bretonneau University Hospital , Tours , France 18. Infectious Disease Department, Faculdade de Ciências Médicas Santa Casa de São Paulo , São Paulo , Brazil 19. Infectious Disease Department, Caremeau University Hospital , Nîmes 20. Infectious Disease Department, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris , Paris 21. Infectious Disease Department, Lille University Hospital , Lille 22. Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris , Paris 23. Mycology Department, Institut Pasteur, Centre National de Référence Mycoses Invasives et Antifongiques, Paris Cité University, Groupe de Recherche Translationnelle en Mycologie , Paris , France 24. Infectious Disease Department, Hospital Clínic de Barcelona , Barcelona , Spain 25. , Joseph Ducuing Hospital Orthopedic surgery department , Toulouse , France 26. Infectious Disease Department, Joseph Ducuing Hospital , Toulouse , France 27. Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna , Speising , Austria
Abstract
Abstract
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.
Publisher
Oxford University Press (OUP)
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