Predictive Factors for Successful Treatment in Candidial Bone and Joint Infection

Abstract

Background Candidiasis is a major cause of morbidity and mortality, causing a diverse spectrum of clinical diseases. Candidial bone and joint infection (CBJI) is a rare clinical disease, although it is one associated with significant morbidity. As most prior studies were limited to individual cases and small case series, there were insufficient data on the epidemiology and outcome of CBJI. The aim of this study is to identify the predictive factors for successful treatment in CBJI.Methods A retrospective review was performed on 33 patients with Candida confirmed on culture, among patients diagnosed with bone and joint infection between January 2006 and December 2016 at a 2400-bed tertiary hospital in South Korea. Unfavorable outcome was defined as recurrence following completion of treatment or mortality. Clinical characteristics, treatment outcome, and medical records were reviewed.ResultsOf the 33 patients, 15 (45.5%) had unfavorable outcomes; recurrence (n = 9) and mortality (n = 6). Median age was 64.0 years (range, 50.5–71.5 years) and there were 14 (42.4%) males. Seventeen (51.5%) patients had arthritis and 16 (48.5%) osteomyelitis. Candida albicans constituted 48.5%, C. parapsilosis 24.2%, C. tropicalis 6.1%, and C. glabrata6.1%. Mechanisms of infection were hematogenous dissemination (57.6%) and direct inoculation (42.4%). There were no significant differences between the favorable outcome group and the unfavorable outcome group for the underlying diseases. The neutrophil percentage in complete blood count at the time of diagnosis showed a difference between the two groups (68.0% vs. 79.6%, P = 0.016). There was a significant difference in neutrophil-lymphocyte ratio (2.2 vs. 4.8, P = 0.023), erythrocyte sedimentation rate (ESR) (40.5 vs. 72.4, P = 0.024) and C-reactive protein (CRP) (15.3 vs. 86.3, P = 0.001) at the end of treatment. The duration of antifungal therapy showed a significant difference (124.9 days vs. 44.3 days, P = 0.041), but there was no difference in the operation. In the multivariate analysis, CRP at the end of treatment (P = 0.028) ws found to be a predictive factor for successful treatment.Conclusion CBJI is a rare disease but associated with high treatment failure. Prolonged antifungal treatment is essential for successful treatment of CBJI, and CRP at the end of treatment is a key predictive marker of successful treatment.Disclosures All authors: No reported disclosures.