Prosthetic Joint Infections due to <i>Candida</i> Species: A Multicenter International Study
Aurélien Dinh, Martin McNally, Emma D’Anglejan, Christel Mamona Kilu, Julie Lourtet, Rosemary Ho, Matthew Scarborough, Maria Dudareva, Gerald Jesuthasan, C. Ronde Oustau, Stéphane Klein, Laura Escolà‐Vergé, Dolores Rodriguez Pardo, Pierre Delobel, Jaime Lora-Tamayo, Mikel Mancheño-Losa, Maria Luisa Sorlí Redó, José María Barbero Allende, C. Arvieux, Danguolė Važnaisienė, Thomas Bauer, Anne‐Laure Roux, Latifa Noussair, Stéphane Corvec, Marta Fernández-Sampedro, Nicolò Rossi, Adrien Lemaignen, Mauro José Costa Salles, Taiana Cunha Ribeiro, Julien Mazet, Milène Sasso, Jean-Philippe Lavigne, Albert Sotto, Etienne Canouï, Éric Senneville, Pauline Thill, Olivier Lortholary, Fanny Lanternier, Laura Morata, Àlex Soriano, Gérard Giordano, C. R. Fourcade, Bernhard J. H. Frank, Jochen G. Hofstaetter, Clara Duran, Eric Bonnet, Thomas Bauer, Camille Courboulès, Emma D’Anglejan, Aurélien Dinh, Clara Duran, Christel Mamona Kilu, Latifa Noussair, Anne‐Laure Roux, Eric Bonnet, C. R. Fourcade, Gérard Giordano, Maria Dudareva, Rosemary Ho, Gerald Jesuthasan, Martin McNally, Matthew Scarborough, Bernhard J. H. Frank, Jochen G. Hofstaetter, Stéphane Klein, C. Ronde Oustau, Éric Senneville, Pauline Thill, Laura Escolà‐Vergé, Dolores Rodriguez Pardo, Laura Morata, Àlex Soriano, Etienne Canouï, A. Paugam, Gertrude Touanga, Pierre Delobel, Jaime Lora-Tamayo, Mikel Mancheño-Losa, Jean-Philippe Lavigne, Milène Sasso, Julien Mazet, Albert Sotto, Juan Gomez Junyent, Maria Luisa Sorlí Redó, Mauro José Costa Salles, Taiana Cunha Ribeiro, José María Barbero Allende, Guillaume Désoubeaux, Adrien Lemaignen, Chloé Porche, C. Arvieux, Anne Méheut, Jean‐Pierre Gangneux, C. Couzigou, Julie Lourtet, B. Pilmis, Justinas Stučinskas, Danguolė Važnaisienė, Nicolò Rossi, Stéphane Corvec
Abstract
BACKGROUND: Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI. METHODS: This was a retrospective observational multinational study including patients diagnosed with Candida-related PJI between 2010 and 2021. Treatment outcome was assessed at 2-year follow-up. RESULTS: A total of 269 patients were analyzed. Median age was 73.0 (interquartile range [IQR], 64.0-79.0) years; 46.5% of patients were male and 10.8% were immunosuppressed. Main infection sites were hip (53.0%) and knee (43.1%), and 33.8% patients had fistulas. Surgical procedures included debridement, antibiotics, and implant retention (DAIR) (35.7%), 1-stage exchange (28.3%), and 2-stage exchange (29.0%). Candida spp identified were Candida albicans (55.8%), Candida parapsilosis (29.4%), Candida glabrata (7.8%), and Candida tropicalis (5.6%). Coinfection with bacteria was found in 51.3% of cases. The primary antifungal agents prescribed were azoles (75.8%) and echinocandins (30.9%), administered for a median of 92.0 (IQR, 54.5-181.3) days. Cure was observed in 156 of 269 (58.0%) cases. Treatment failure was associated with age >70 years (OR, 1.811 [95% confidence interval {CI}: 1.079-3.072]), and the use of DAIR (OR, 1.946 [95% CI: 1.157-3.285]). Candida parapsilosis infection was associated with better outcome (OR, 0.546 [95% CI: .305-.958]). Cure rates were significantly different between DAIR versus 1-stage exchange (46.9% vs 67.1%, P = .008) and DAIR versus 2-stage exchange (46.9% vs 69.2%, P = .003), but there was no difference comparing 1- to 2-stage exchanges (P = .777). CONCLUSIONS: Candida PJI prognosis seems poor, with high rate of failure, which does not appear to be linked to immunosuppression, use of azoles, or treatment duration.