Prosthetic Joint Infections Caused by Candida Species

A Systematic Review and a Case Series

Yoo Ra Lee, Hyun Jung Kim, Eun Ju Lee, Jang Wook Sohn, Ja Kim Min, Young Kyung Yoon

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The purpose of this study was to evaluate the efficacy of echinocandins in the treatment of Candida prosthetic joint infection (PJI) based on published literature and on patients we examined. A structured literature review of multiple databases was conducted to identify patients who received echinocandins for Candida PJIs. Additionally, we describe here the first cases of PJIs due to C. parapsilosis, successfully treated with prolonged anidulafungin therapy. Out of 17 patients, 12 were female and the mean age at diagnosis was 66.0 years. No risk factors associated with Candida PJIs were found in four patients (23.5%). Infection sites included the knee (n = 10, 62.5%), the hip (n = 6, 35.3%) and the shoulder (n = 1, 5.9%). The most frequently isolated Candida species were C. albicans (n = 7, 41.2%) and C. glabrata (n = 7, 41.2%), followed by C. parapsilosis (n = 2, 11.8%) and C. freyschussii (n = 1, 5.9%). All patients were cured with the combination of systemic antifungal therapy and surgical interventions. Two-stage exchange arthroplasty and resection arthroplasty were performed in five and nine patients, respectively. The most frequently used echinocandins were caspofungin (n = 11, 64.7%), followed by anidulafungin (n = 4, 23.5%) and micafungin (n = 2, 11.8%). The median duration (days) of echinocandin therapy was as follows: caspofungin (25.5, range 8–56), micafungin (14.0, range 4–56) and anidulafungin (58, range 14–90). This study supports the effective role of echinocandins, as well as the potential advantage of surgical intervention in the treatment of Candida PJIs. Furthermore, it provides fundamental data on the safety of long-term echinocandin therapy.

Original languageEnglish
JournalMycopathologia
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Echinocandins
systematic review
Candida
anidulafungin
Joints
caspofungin
Infection
infection
Candida parapsilosis
therapeutics
Arthroplasty
Therapeutics
Candida glabrata
knees
resection
hips
shoulders
Candida albicans
echinocandins
Hip

Keywords

  • Candida
  • Echinocandins
  • Infectious arthritis
  • Prosthesis-related infections

ASJC Scopus subject areas

  • Microbiology
  • Applied Microbiology and Biotechnology
  • Agronomy and Crop Science
  • veterinary (miscalleneous)

Cite this

Prosthetic Joint Infections Caused by Candida Species : A Systematic Review and a Case Series. / Lee, Yoo Ra; Kim, Hyun Jung; Lee, Eun Ju; Sohn, Jang Wook; Min, Ja Kim; Yoon, Young Kyung.

In: Mycopathologia, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "The purpose of this study was to evaluate the efficacy of echinocandins in the treatment of Candida prosthetic joint infection (PJI) based on published literature and on patients we examined. A structured literature review of multiple databases was conducted to identify patients who received echinocandins for Candida PJIs. Additionally, we describe here the first cases of PJIs due to C. parapsilosis, successfully treated with prolonged anidulafungin therapy. Out of 17 patients, 12 were female and the mean age at diagnosis was 66.0 years. No risk factors associated with Candida PJIs were found in four patients (23.5{\%}). Infection sites included the knee (n = 10, 62.5{\%}), the hip (n = 6, 35.3{\%}) and the shoulder (n = 1, 5.9{\%}). The most frequently isolated Candida species were C. albicans (n = 7, 41.2{\%}) and C. glabrata (n = 7, 41.2{\%}), followed by C. parapsilosis (n = 2, 11.8{\%}) and C. freyschussii (n = 1, 5.9{\%}). All patients were cured with the combination of systemic antifungal therapy and surgical interventions. Two-stage exchange arthroplasty and resection arthroplasty were performed in five and nine patients, respectively. The most frequently used echinocandins were caspofungin (n = 11, 64.7{\%}), followed by anidulafungin (n = 4, 23.5{\%}) and micafungin (n = 2, 11.8{\%}). The median duration (days) of echinocandin therapy was as follows: caspofungin (25.5, range 8–56), micafungin (14.0, range 4–56) and anidulafungin (58, range 14–90). This study supports the effective role of echinocandins, as well as the potential advantage of surgical intervention in the treatment of Candida PJIs. Furthermore, it provides fundamental data on the safety of long-term echinocandin therapy.",
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