A Candida Glabrata-Associated Prosthetic Joint Infection: Case Report and Literature Review.

Abstract

Background: Candida glabrata (C. glabrata) is an opportunistic fungal pathogen that has emerged as a potential risk for orthopedic prosthetic hardware infection. This case report highlights the clinical significance, management strategies, and evolving trends in the treatment of these complex infections.

Case presentation: A male Vietnam War veteran presented to the emergency department in July 2023 with pain and a large fluid collection over the surgical site on his left hip. The patient had a complex orthopedic history, having undergone total left hip arthroplasty in 1996, in addition to open reduction internal fixation about 9 months prior to presentation. On admission, the patient was afebrile and normotensive, with an elevated erythrocyte sedimentation rate and C-reactive protein. Bedside irrigation and debridement were performed, and synovial fluid analysis revealed an elevated white blood cell count, negative bacterial cultures, and the presence of C. glabrata. The patient started receiving intravenous micafungin 100 mg/day as empiric antifungal therapy. Wound cultures obtained during debridement and implant retention were positive for C. glabrata, Enterococcus faecalis, Staphylococcus epidermidis, and Corynebacterium tuberculostearicum. These findings necessitated a chronic suppressive antibiotic and antifungal regimen, in addition to ongoing local wound care for persistent serosanguinous fluid drainage. The patient opted for a 2-staged revision arthroplasty after shared decision-making with his family and orthopedic surgery team.

Conclusions: This report underscores the importance of a multidisciplinary approach in managing C. glabrata-related prosthetic joint infections, along with early detection and initiation of prompt therapy for positive patient outcomes. In addition, this report emphasizes the need for greater awareness and research into this rare but challenging infectious complication in patients undergoing similar orthopedic procedures.