Abstract
Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.
Highlights
Prosthetic joint infection (PJI) involves the joint prosthesis and contiguous tissue and is one of the main reasons for total arthroplasty failure [1, 2]
We describe one patient seen at the Orthopaedics and Trauma Department of the Hospital Universitario Virgen de las Nieves (Granada, Spain) with PJI due to C. albicans which is being treated with antifungal drugs alone
Risk factors for candidal infection, including immunosuppression, systemic disease and/or long-term antibiotics use, may play an essential role in the development of invasive candidal infections other factors could be involved in triggering the infection, specially the presence of biofilm on bioprosthetic surfaces
Summary
Prosthetic joint infection (PJI) involves the joint prosthesis and contiguous tissue and is one of the main reasons for total arthroplasty failure [1, 2]. In January 2015, the patient underwent a two-stage right knee arthroplasty for septic arthritis due to S. epidermidis, as well as treatment with vancomycin + gentamycin. He was immunocompromised due to a splenectomy performed several years ago. The sample was inoculated in aerobic and anaerobic blood agar (BD Columbia Agar 5% Sheepblood®, Becton Dickinson), chocolate agar (BD Choco Agar, Becton Dickinson) and thioglycolate broth (BDTM Fluid Thioglycollate Medium, Becton Dickinson), all incubated at 37o C., and chromogenic candida agar (CandiSelect TM, Bio-Rad, Redmond, WA, USA) incubated at 30o C. The patient has rejected prosthesis reimplantation and is currently waiting for a 6 months of antifungal treatment
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