Prosthetic Joint Infections due to Candida Species: A Multicenter International Study.
Candida spp
echinocandins
mortality
prosthetic joint infection
superinfection
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
27 Aug 2024
27 Aug 2024
Historique:
received:
28
03
2024
medline:
27
8
2024
pubmed:
27
8
2024
entrez:
27
8
2024
Statut:
aheadofprint
Résumé
Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI. 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. 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). 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.
Sections du résumé
BACKGROUND
BACKGROUND
Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI.
METHODS
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
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
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.
Identifiants
pubmed: 39189831
pii: 7742287
doi: 10.1093/cid/ciae395
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Thomas Bauer
(T)
Camille Courboulès
(C)
Emma d'Anglejan
(E)
Aurélien Dinh
(A)
Clara Duran
(C)
Christel Mamona Kilu
(CM)
Latifa Noussair
(L)
Anne-Laure Roux
(AL)
Eric Bonnet
(E)
Camille Fourcade
(C)
Gérard Giordano
(G)
Maria Dudareva
(M)
Rosemary Ho
(R)
Gerald Jesuthasan
(G)
Martin McNally
(M)
Matthew Scarborough
(M)
Bernhard J H Frank
(BJH)
Jochen G Hofstätter
(JG)
Stephane Klein
(S)
Cecile Ronde Oustau
(CR)
Éric Senneville
(É)
Pauline Thill
(P)
Laura Escolà-Vergé
(L)
Dolores Rodriguez Pardo
(DR)
Laura Morata
(L)
Alex Soriano
(A)
Etienne Canouï
(E)
André Paugam
(A)
Gertrude Touanga
(G)
Pierre Delobel
(P)
Jaime Lora-Tamayo
(J)
Mikel Mancheño-Losa
(M)
Jean-Philippe Lavigne
(JP)
Milène Sasso
(M)
Julien Mazet
(J)
Albert Sotto
(A)
Juan Gomez Junyent
(JG)
Maria Luisa Sorlí Redó
(MLS)
Mauro José Costa Salles
(MJ)
Taiana Cunha Ribeiro
(TC)
José Maria Barbero Allende
(JMB)
Guillaume Desoubeaux
(G)
Adrien Lemaignen
(A)
Chloé Porche
(C)
Cédric Arvieux
(C)
Anne Méheut
(A)
Jean-Pierre Gangneux
(JP)
Carine Couzigou
(C)
Julie Lourtet
(J)
Benoît Pilmis
(B)
Justinas Stucinskas
(J)
Danguole Vaznaisiene
(D)
Nicolò Rossi
(N)
Stéphane Corvec
(S)
Vincent Crenn
(V)
Florent Morio
(F)
Marta Fernández-Sampedro
(M)
Fanny Lanternier
(F)
Olivier Lortholary
(O)
Informations de copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Déclaration de conflit d'intérêts
Potential conflicts of interest. The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.