Candida periprosthetic joint infections \u2014 risk factors and outcome between albicans and non-albicans strains

Daniel Karczewski,Arne Kienzle,Yi Ren,Octavian Andronic,Carsten Perka,Michael Müller,Doruk Akgün

doi:10.1007/s00264-021-05214-y

Abstract

BackgroundDespite its scarcity, fungal periprosthetic joint infection (PJI) is of great clinical relevance as diagnosis and treatment are highly challenging. Previous analyses focused on the treatment rather than the role of the causative fungal agent on clinical outcome. This is the largest study of its kind to evaluate Candida strain–dependent differences in patients with fungal PJI.MethodsWe retrospectively analyzed 29 patients who underwent surgical intervention due to Candida hip or knee PJI in our department from 2010 to 2018. PJI was defined according to IDSA, recurrent PJI according to modified Delphi consensus criteria. Statistical analysis was performed using t-test, chi-square test with Yates correction, and log rank test.ResultsBesides age and affected joint, no significant differences were found between Candida albicans and non-albicans PJI patients (75.83 versus 64.11 years, p = 0.012; 12 hip versus two knee cases, p = 0.013). Most patients received two- (27.59%) or three-stage exchange surgery (41.38%). There was a statistical trend towards an increase in surgery needed in non-albicans Candida PJI (2.92 versus 2.12; p = 0.103). After initial Candida PJI treatment, functional prosthesis implantation was achieved in 72.41% of all patients. At last follow-up, infection-free survival was at 26.79% in Candida albicans versus 72.00% in non-albicans PJI (p = 0.046).ConclusionsIn this study, we found infection-free survival rates to be significantly decreased in patients with albicans compared to non-albicans Candida PJI. While age and affected joint might play a confounding role, we speculate the causative pathogen to play a decisive role in disease progression.

Highlights

Despite increased routine usage of antibiotic prophylaxis and improved aseptic surgical techniques, periprosthetic joint infection (PJI) is still a common yet severe complication after both TKA and THA [1,2,3,4,5]
We assessed clinical and paraclinical data to study potential differences in patient demographics, treatment, and clinical outcome in patients with PJI due to Candida albicans versus non-albicans Candida strains at our university hospital
Long-term infection-free survival rate was significantly lower in patients with Candida albicans PJI compared to non-albicans Candida PJI

Summary

Introduction

Despite increased routine usage of antibiotic prophylaxis and improved aseptic surgical techniques, periprosthetic joint infection (PJI) is still a common yet severe complication after both TKA and THA [1,2,3,4,5]. Despite its clinical relevance, little research has focused on systematically exploring differences in distribution, clinical features, and outcome. This lack of knowledge on Candida strain–dependent patient characteristics and clinical outcome leads to a paucity in differential and targeted treatment approaches. We retrospectively analyzed the cases of 29 patients who underwent surgical intervention due to Candida PJI. This is the largest study of its kind to evaluate Candida strain–dependent differences in patients affected by this pathology. Risk factors, clinical and paraclinical parameters, and long-term outcome were assessed and compared for patients suffering from Candida albicans PJI and non-albicans Candida PJI

Material and methods

Results

Discussion