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
{"title":"由念珠菌引起的人工关节感染：一项多中心国际研究。","authors":"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","doi":"10.1093/cid/ciae395","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":8.2000,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prosthetic Joint Infections due to Candida Species: A Multicenter International Study.\",\"authors\":\"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\",\"doi\":\"10.1093/cid/ciae395\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":10463,\"journal\":{\"name\":\"Clinical Infectious Diseases\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":8.2000,\"publicationDate\":\"2024-08-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/cid/ciae395\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/cid/ciae395","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Prosthetic Joint Infections due to Candida Species: A Multicenter International Study.
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.
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.
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