Department of Orthopedics, Medical University of South Carolina, Charleston, SC.
Midwest Orthopedics at Rush University Medical College, Chicago, IL.
J Arthroplasty. 2021 May;36(5):1758-1764. doi: 10.1016/j.arth.2020.11.005. Epub 2020 Nov 12.
Periprosthetic joint infection (PJI) is one of the most feared complications of total joint arthroplasty (TJA). Although commonly the result of colonization by Staphylococcal species, a growing number of cases of PJI with fungal pathogens have been reported within the last decade. Although standard treatment with two-stage exchange mirrors that of bacterial PJI, the variability in virulence between fungal species makes for an unpredictable and challenging treatment course.
A review of Pubmed and Scopus from years 2009 to 2019 was conducted with the search terms fungal, infection, Candida, arthroplasty, periprosthetic, and prosthesis. Publications were reviewed and screened, yielding data for 286 patients with fungal PJI in the hip, knee, shoulder, and elbow prosthetics.
Patient comorbidities generally included conditions impairing wound healing and immune response such as diabetes mellitus. Candida species were the most common fungal pathogens identified (85%); 30% had a concomitant bacterial infection. A two-stage exchange was most utilized, with a mean success rate of 65%. Antifungal impregnated spacers were utilized in 82 cases, with a comparatively high success rate (81%). Attempts at debridement with implant retention had substantially lower cure rates (15%).
Two-stage exchange is the favored approach to treating fungal PJI. Debridement with implant retention does not appear adequate to control infection, and retrieval of implanted materials should be prioritized. The use of antifungal impregnated spacers is an important area of ongoing research, with uncertainty regarding the type and quantity of antifungal agent to incorporate, although recent reports support the use of these agents.
人工关节置换术后感染（PJI）是全关节置换术（TJA）最可怕的并发症之一。尽管通常是葡萄球菌定植的结果，但在过去十年中，越来越多的真菌病原体引起的 PJI 病例被报道。虽然两阶段置换术的标准治疗与细菌性 PJI 相同，但真菌种间毒力的差异导致治疗过程不可预测且具有挑战性。
对 2009 年至 2019 年的 Pubmed 和 Scopus 进行了回顾，检索词为真菌、感染、念珠菌、关节置换术、假体周围和假体。对出版物进行了审查和筛选，为髋、膝、肩和肘假体的 286 例真菌性 PJI 患者提供了数据。
患者的合并症通常包括影响伤口愈合和免疫反应的疾病，如糖尿病。念珠菌是最常见的真菌病原体（85%）；30%的患者合并细菌感染。最常采用两阶段置换术，平均成功率为 65%。在 82 例病例中使用了抗真菌浸渍间隔物，成功率较高（81%）。保留植入物进行清创术的治愈率明显较低（15%）。
两阶段置换术是治疗真菌性 PJI 的首选方法。保留植入物的清创术似乎不足以控制感染，应优先取出植入物材料。抗真菌浸渍间隔物的使用是一个正在进行的研究的重要领域，虽然最近的报告支持使用这些药物，但在抗真菌药物的类型和数量方面仍存在不确定性。
