Candida periprosthetic joint infection: A rare and difficult-to-treat infection

BACKGROUND: Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies. METHODS: We conducted a multicenter retrospective stud...

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Autores: Escolà-Vergé, Laura, Sorli Redó, M. Luisa, Pigrau, C., Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spanish Network for Research in Infectious Pathology (REIPI)
Formato: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2018
País:España
Recursos:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:10230/41684
Acesso em linha:http://hdl.handle.net/10230/41684
http://dx.doi.org/10.1016/j.jinf.2018.03.012
Access Level:acceso abierto
Palavra-chave:2-stage treatment
Antibiofilm agents
Antifungal-loaded bone cement
Candida
Echinocandins
Fungal periprosthetic infection
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spelling Candida periprosthetic joint infection: A rare and difficult-to-treat infectionEscolà-Vergé, LauraSorli Redó, M. LuisaPigrau, C.Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC)Spanish Network for Research in Infectious Pathology (REIPI)2-stage treatmentAntibiofilm agentsAntifungal-loaded bone cementCandidaEchinocandinsFungal periprosthetic infectionBACKGROUND: Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies. METHODS: We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 in 16 Spanish hospitals. RESULTS: Forty-three patients included: median age, 75 years, and median Charlson Comorbidity Index score, 4. Thirty-four (79.1%) patients had ≥1 risk factor for Candida infection. Most common causative species were C. albicans and C. parapsilosis. Thirty-five patients were evaluable for outcome: overall, treatment succeeded in 17 (48.6%) and failed in 18 (51.4%). Success was 13/20 (67%) in patients with prosthesis removal and 4/15 (27%) with debridement and prosthesis retention (p = 0.041). All 3 patients who received an amphotericin B-impregnated cement spacer cured. In the prosthesis removal group, success was 5/6 (83%) with an antibiofilm regimen and 8/13 (62%) with azoles (p = 0.605). In the debridement and prosthesis retention group, success was 3/10 (30%) with azoles and 1/5 (20%) with antibiofilm agents. Therapeutic failure was due to relapse in 9 patients, need for suppressive treatment in 5, persistent infection in 2, and CPJI-related death in 2; overall attributable mortality was 6%. CONCLUSIONS: CPJI is usually a chronic disease in patients with comorbidities and risk factors for Candida infection. Treatment success is low, and prosthesis removal improves outcome. Although there is insufficient evidence that use of antifungals with antibiofilm activity has additional benefits, our experience indicates it may be recommendable.Elsevier20192018info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/41684http://dx.doi.org/10.1016/j.jinf.2018.03.012reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésJournal of Infection. 2018 Aug;77(2):151-7© Elsevier http://dx.doi.org/10.1016/j.jinf.2018.03.012info:eu-repo/semantics/openAccessoai:recercat.cat:10230/416842026-05-29T05:05:01Z
dc.title.none.fl_str_mv Candida periprosthetic joint infection: A rare and difficult-to-treat infection
title Candida periprosthetic joint infection: A rare and difficult-to-treat infection
spellingShingle Candida periprosthetic joint infection: A rare and difficult-to-treat infection
Escolà-Vergé, Laura
2-stage treatment
Antibiofilm agents
Antifungal-loaded bone cement
Candida
Echinocandins
Fungal periprosthetic infection
title_short Candida periprosthetic joint infection: A rare and difficult-to-treat infection
title_full Candida periprosthetic joint infection: A rare and difficult-to-treat infection
title_fullStr Candida periprosthetic joint infection: A rare and difficult-to-treat infection
title_full_unstemmed Candida periprosthetic joint infection: A rare and difficult-to-treat infection
title_sort Candida periprosthetic joint infection: A rare and difficult-to-treat infection
dc.creator.none.fl_str_mv Escolà-Vergé, Laura
Sorli Redó, M. Luisa
Pigrau, C.
Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC)
Spanish Network for Research in Infectious Pathology (REIPI)
author Escolà-Vergé, Laura
author_facet Escolà-Vergé, Laura
Sorli Redó, M. Luisa
Pigrau, C.
Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC)
Spanish Network for Research in Infectious Pathology (REIPI)
author_role author
author2 Sorli Redó, M. Luisa
Pigrau, C.
Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC)
Spanish Network for Research in Infectious Pathology (REIPI)
author2_role author
author
author
author
dc.subject.none.fl_str_mv 2-stage treatment
Antibiofilm agents
Antifungal-loaded bone cement
Candida
Echinocandins
Fungal periprosthetic infection
topic 2-stage treatment
Antibiofilm agents
Antifungal-loaded bone cement
Candida
Echinocandins
Fungal periprosthetic infection
description BACKGROUND: Candida periprosthetic joint infection (CPJI) is a rare, difficult-to-treat disease. The purpose of this study was to evaluate the clinical characteristics and outcomes of CPJI treated with various surgical and antifungal strategies. METHODS: We conducted a multicenter retrospective study of all CPJI diagnosed between 2003 and 2015 in 16 Spanish hospitals. RESULTS: Forty-three patients included: median age, 75 years, and median Charlson Comorbidity Index score, 4. Thirty-four (79.1%) patients had ≥1 risk factor for Candida infection. Most common causative species were C. albicans and C. parapsilosis. Thirty-five patients were evaluable for outcome: overall, treatment succeeded in 17 (48.6%) and failed in 18 (51.4%). Success was 13/20 (67%) in patients with prosthesis removal and 4/15 (27%) with debridement and prosthesis retention (p = 0.041). All 3 patients who received an amphotericin B-impregnated cement spacer cured. In the prosthesis removal group, success was 5/6 (83%) with an antibiofilm regimen and 8/13 (62%) with azoles (p = 0.605). In the debridement and prosthesis retention group, success was 3/10 (30%) with azoles and 1/5 (20%) with antibiofilm agents. Therapeutic failure was due to relapse in 9 patients, need for suppressive treatment in 5, persistent infection in 2, and CPJI-related death in 2; overall attributable mortality was 6%. CONCLUSIONS: CPJI is usually a chronic disease in patients with comorbidities and risk factors for Candida infection. Treatment success is low, and prosthesis removal improves outcome. Although there is insufficient evidence that use of antifungals with antibiofilm activity has additional benefits, our experience indicates it may be recommendable.
publishDate 2018
dc.date.none.fl_str_mv 2018
2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/41684
http://dx.doi.org/10.1016/j.jinf.2018.03.012
url http://hdl.handle.net/10230/41684
http://dx.doi.org/10.1016/j.jinf.2018.03.012
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Journal of Infection. 2018 Aug;77(2):151-7
dc.rights.none.fl_str_mv © Elsevier http://dx.doi.org/10.1016/j.jinf.2018.03.012
info:eu-repo/semantics/openAccess
rights_invalid_str_mv © Elsevier http://dx.doi.org/10.1016/j.jinf.2018.03.012
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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