Department of Orthopaedics, KEPCO Medical Center, Korea Electric Power Corporation (KEPCO) Medical Foundation, Seoul, Republic of Korea.
Mycopathologia. 2015 Apr;179(3-4):173-85. doi: 10.1007/s11046-014-9852-3. Epub 2014 Dec 30.
Candida species (Candida spp.) infection following total hip arthroplasty (THA) is a rare but potentially devastating complication. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of Candida spp. infection after THA. We conducted a systemic review of the literature and pooled analysis of Candida spp. infection after THA published between 1950 and 2014. A total of 20 articles with 37 patients were identified. Median time between THA and readmission for Candida spp. infection was 25 months (range 0.5-184 months). Thirty-two patients (87%) underwent removal of the prosthesis for initial surgical treatment. All patients were treated with systemic antifungal medication therapy for various durations after the surgical procedure or primary therapy without surgical procedures except for one patient who was treated with only amphotericin B joint cavity irrigation after removal of the prosthesis. Relapse of the infection occurred in three patients who had retention of the original prosthesis. There were three deaths related to the Candida spp. infection following THA owing to uncontrolled Candida spp. infection and deteriorating candidemia sepsis. Of note, among 15 patients who underwent two-stage exchange arthroplasty, there was one patient (7%) who developed complication (death) while other 14 patients had uncomplicated recovery. In conclusion, surgical debridement with removal of the original prosthesis or two-stage exchange arthroplasty with combination of adequate systemic antifungal therapy is highly recommended in the treatment of Candida spp. infection following THA.
全髋关节置换术后念珠菌属（Candida spp.）感染是一种罕见但潜在破坏性的并发症。本研究旨在提供全髋关节置换术后念珠菌属感染治疗和结局的循证总结。我们对 1950 年至 2014 年间发表的全髋关节置换术后念珠菌属感染的文献进行了系统性回顾和汇总分析。共确定了 20 篇文章，涉及 37 例患者。全髋关节置换术后至念珠菌属感染再入院的中位时间为 25 个月（范围 0.5-184 个月）。32 例患者（87%）接受了假体取出作为初始手术治疗。所有患者在手术后或初次治疗（无手术）时均接受了不同时间的全身性抗真菌药物治疗，除 1 例患者在取出假体后仅接受两性霉素 B 关节腔灌洗治疗。3 例保留原假体的患者出现感染复发。有 3 例患者因念珠菌属感染未能控制和播散性念珠菌血症败血症而死亡。值得注意的是，在接受二期关节置换术的 15 例患者中，有 1 例（7%）患者出现并发症（死亡），而其他 14 例患者恢复顺利。总之，对于全髋关节置换术后念珠菌属感染，建议采用手术清创联合取出原假体或二期关节置换术，同时结合充分的全身性抗真菌治疗。
