Prosthetic Joint Infections due to Candida Species: A Multicenter International Study.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases Pub Date : 2024-08-27 DOI:10.1093/cid/ciae395

Aurélien Dinh, Martin McNally, Emma D'Anglejan, Christel Mamona Kilu, Julie Lourtet, Rosemary Ho, Matthew Scarborough, Maria Dudareva, Gerald Jesuthasan, Cecile 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, Cédric Arvieux, Danguole Vaznaisiène, 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, Alex Soriano, Gérard Giordano, Camille Fourcade, Bernhard J H Franck, Jochen G Hofstätter, Clara Duran, Eric Bonnet

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引用次数: 0

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.

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由念珠菌引起的人工关节感染：一项多中心国际研究。

背景：由念珠菌引起的人工关节感染（PJI）是关节成形术的一种严重并发症。我们调查了念珠菌 PJI 的治疗效果：这是一项回顾性跨国观察研究，研究对象包括 2010 年至 2021 年间被诊断为念珠菌相关 PJI 的患者。结果：共分析了 269 例患者：结果：共分析了 269 例患者。中位年龄为 73.0 岁（四分位数间距 [IQR]，64.0-79.0）；46.5% 的患者为男性，10.8% 的患者为免疫抑制患者。主要感染部位为髋关节（53.0%）和膝关节（43.1%），33.8%的患者有瘘管。手术程序包括清创、抗生素和植入物保留（DAIR）（35.7%）、1阶段置换（28.3%）和2阶段置换（29.0%）。确定的念珠菌属包括白色念珠菌（55.8%）、副丝状念珠菌（29.4%）、光滑念珠菌（7.8%）和热带念珠菌（5.6%）。51.3%的病例合并细菌感染。处方的主要抗真菌药物为唑类（75.8%）和棘白菌素类（30.9%），用药时间中位数为 92.0 天（IQR，54.5-181.3 天）。269 例病例中有 156 例（58.0%）治愈。治疗失败与年龄大于 70 岁（OR，1.811 [95% 置信区间{CI}：1.079-3.072]）和使用 DAIR（OR，1.946 [95% CI：1.157-3.285]）有关。副丝状念珠菌感染与较好的疗效相关（OR，0.546 [95% CI：.305-.958]）。DAIR与1级换药相比（46.9% vs 67.1%，P = .008），DAIR与2级换药相比（46.9% vs 69.2%，P = .003），治愈率有明显差异，但1级换药与2级换药相比没有差异（P = .777）：结论：念珠菌 PJI 的预后似乎很差，失败率很高，这似乎与免疫抑制、使用唑类药物或治疗时间长短无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.