From the Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical Center , New York.
Infect Dis (Lond). 2015 Mar;47(3):144-9. doi: 10.3109/00365548.2014.974207. Epub 2014 Dec 24.
Current guidelines for treatment of Candida osteoarticular infections (COAIs) recommend a prolonged course of antifungal therapy (AFT) of 6-12 months. Based upon strategies developed at the Hospital for Special Surgery (HSS), we hypothesized that the duration of antifungal therapy may be substantially reduced for management of COAI.
This was a retrospective chart review of cases of COAI treated at the HSS for the past 14 years. COAI was documented by open biopsy and direct culture in all cases. The mean (95% confidence interval, CI) duration of documented follow-up was 39 (16-61) months.
Among the 23 cases of COAI, the median age was 62 years (range 22-83 years) with 61% having no underlying condition. Orthopedic appliances, including joint prostheses and fracture hardware, were present in 74% of cases. All patients had COAI as the first proven site of candidiasis. Candida albicans and Candida parapsilosis were the most common species. Hip, knee, foot, and ankle were the most common sites. All patients received aggressive surgical intervention followed by AFT administered for a mean (95% CI) duration of 45 (38-83) days. Systemic AFT consisted principally of fluconazole alone (65%) or in combination with other agents (26%). Adjunctive intraoperative amphotericin B irrigation was used in 35%. Among eight cases of CAOI that required placement of a new prosthetic joint, all were successfully treated. There were no microbiologic failures.
Candida osteoarticular infections may be successfully treated with substantially limited durations of AFT when combined with a thorough surgical approach.
目前治疗念珠菌性骨关节炎感染（COAI）的指南建议使用抗真菌治疗（AFT）的疗程为 6-12 个月。基于特种外科医院（HSS）制定的策略，我们假设对于 COAI 的管理，抗真菌治疗的持续时间可以大大缩短。
这是一项对过去 14 年来在 HSS 治疗 COAI 的病例进行的回顾性图表审查。所有病例均通过开放性活组织检查和直接培养来确定 COAI。记录的随访平均（95%置信区间，CI）时间为 39（16-61）个月。
在 23 例 COAI 中，中位年龄为 62 岁（范围 22-83 岁），61%的患者没有基础疾病。在 74%的病例中存在骨科器械，包括关节假体和骨折固定器。所有患者的 COAI 均为首次确诊的念珠菌感染部位。最常见的物种是白色念珠菌和近平滑念珠菌。髋关节、膝关节、足部和踝关节是最常见的部位。所有患者均接受了积极的手术干预，随后接受了平均（95%CI）45（38-83）天的 AFT 治疗。全身 AFT 主要由氟康唑单独（65%）或与其他药物联合使用（26%）组成。35%的患者采用了术中辅助两性霉素 B冲洗。在需要植入新的关节假体的 8 例 CAOI 中，所有患者均成功治疗。无微生物学失败。
当与彻底的手术方法相结合时，念珠菌性骨关节炎感染可以通过使用抗真菌治疗的持续时间大大缩短而成功治疗。
