Abstract
BackgroundPeriprosthetic fungal infections are considered rare and opportunistic infections. Treatment is difficult, and established standards do not yet exist. The choice of the appropriate antifungal drug might affect the patient outcome.CasesAll the three cases presented showed polybacterial recurrent infection of the revision hip arthroplasty. All patients were of younger age, had multiple revisions of the endoprosthesis, each had a large partial femoral replacement greater than 40% of the femoral length, gentamycin-loaded cement, and a long anchoring distance of the used intramedullary stem. Due to the severe life-threatening infection with deep osteomyelitis, an amputation had to be performed. However, despite surgical intervention, the fungal dominated infection persisted. Finally, only the use of caspofungin allowed permanent infection control.ConclusionThe polybacterial infection is driven by the symbiosis between fungi and bacteria. Therefore, eradication of the fungus is required to achieve elimination of the bacteria. Antimycotics of the echinocandin-class, such as caspofungin, may be considered as initial treatment.
Highlights
Periprosthetic fungal infections are considered rare and opportunistic infections
The polybacterial infection is driven by the symbiosis between fungi and bacteria
Despite the use of four different antibiotics, the final turning point was the start of antifungal therapy with caspofungin for 28 days after evidence of a C. albicans infection in the amputation stump
Summary
In these clinical cases with high but different risk profiles, a standardized treatment could not avoid the amputation of the affected limb with periprosthetic infection. Massive debridement and complete implant removal accompanied by antibiotic therapy were not successful. There was a delayed detection of candidiasis. With the combination of further surgical intervention and the use of echinocandin-class antimycotics, the complex infection situation was controlled. We regard fungal infections as opportunistic infections, but as the crucial factor in the persistence of complex infections. The initial treatment with a biofilm penetrating fungicide in mixed fungal and bacterial infections might be highly advantageous
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
