Non-albicans Candida prosthetic joint infections: A systematic review of treatment.

Content Provider	Europe PMC
Author	Koutserimpas, Christos Zervakis, Stylianos G Maraki, Sofia Alpantaki, Kalliopi Ioannidis, Argyrios Kofteridis, Diamantis P Samonis, George
Copyright Year	2019
Abstract	BACKGROUNDNon-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far.AIMTo clarify treatment of non-albicans Candida PJIs.METHODSA literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up.RESULTSA total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases; 54.2%), followed by C. glabrata (18 cases; 21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59; 71%), followed by amphotericin B (41; 49.4%).CONCLUSIONThe combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.
Volume Number	7
PubMed Central reference number	PMC6656666
Issue Number	12
PubMed reference number	31363471
Journal	World Journal of Clinical Cases
e-ISSN	23078960
DOI	10.12998/wjcc.v7.i12.1430
Language	English
Publisher	Baishideng Publishing Group Inc
Publisher Date	2019-06-01
Access Restriction	Open
Rights License	This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Subject Keyword	Fungal prosthetic joint infection Knee arthroplasty infection Hip arthroplasty infection Antifungal treatment Non-albicans Candida prosthetic joint infections
Content Type	Text
Resource Type	Article
Subject	Medicine