Periprosthetic Joint Infections Caused by Species-A Single-Center Experience and Systematic Review of the Literature.

BACKGROUND

The aim of this study was to analyze the treatment results of fungal periprosthetic joint infections (PJI) caused by species from a single orthopedic center and to compare them with reports from other institutions.

METHODS

Eight patients operated on from January 2014 to December 2021 met the inclusion criteria and were analyzed in terms of clinical outcomes. A systematic review of the literature identified 153 patients with PJIs extracted from 12 studies according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

The success rate of the treatment in the case series was 50%. The most frequent pathogens were (three cases; 37.5%) and (three cases; 37.5%). In one patient (12.5%), bacterial co-infection was noted, and in five patients (62.5%) significant risk factors of PJI were confirmed. The overall success rate on the basis of data collected for systematic review was 65.5%. A sub-analysis of 127 patients revealed statistically significant differences ( = 0.02) with a higher success rate for the knees (77.6%) than for the hips (58%). In 10 studies the analysis of risk factors was performed and among 106 patients in 77 (72.6%) comorbidities predispose to fungal PJI were confirmed. Bacterial co-infection was noted in 84 patients (54.9%). In 93 patients (60.7%) was the culprit pathogen, and in 39 patients (25.5%) was the culprit pathogen. Based on these two most frequent species causing PJI, the success rate of the treatment was statistically different ( = 0.03), and was 60.3% and 83.3%, respectively. The two-stage strategy was more favorable for patients with infections (94.4% success rate) than the one-stage protocol (50% success rate; = 0.02); as well as in comparison to the two-stage treatment of (65% success rate; = 0.04).

CONCLUSIONS

The analysis of the literature showed no differences in the overall success rate between one- and two-stage surgical strategies for all species, but differed significantly comparing the two most frequent strains and concerning PJI localization. The frequent presence of bacterial co-infections makes it necessary to consider the additional administration of antibiotics in the case of fungal PJI.