Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China.
Medicine (Baltimore). 2023 Nov 24;102(47):e36246. doi: 10.1097/MD.0000000000036246.
Fungal periprosthetic joint infections (fPJIs) are relatively uncommon, accounting for approximately 1% of all PJIs. Revision surgery is typically recommended for fungal infections; however, the physical and financial impact on patients is significant. In this report, we present a case of fPJI successfully treated with debridement, antibiotics, and implant retention (DAIR) with a favorable outcome over a 5-year period.
A 56-year-old male patient presented with a non-healing surgical incision 1 week after undergoing primary total knee arthroplasty on the right side.
Microbiological culture of the wound effusion identified Candida parapsilosis. Postoperatively, the patient exhibited a significant decrease in serum albumin levels and poor glycemic control. Both C-reactive protein and erythrocyte sedimentation rate were elevated.
A comprehensive DAIR procedure was performed, along with continuous closed irrigation using fluconazole for 1 week. The patient received intravenous voriconazole for 4 weeks, followed by oral fluconazole for an additional 3 months.
At 1- and 5-year follow-up appointments, the patient C-reactive protein and erythrocyte sedimentation rate levels were within normal limits, and there was no evidence of swelling, erythema, or tenderness in the right knee joint, indicating no signs of infection.
DAIR is an effective treatment for early fPJIs, and continuous closed irrigation may provide specific advantages. The patient nutritional status plays a crucial role in the management of periprosthetic infections.
真菌性假体周围关节感染（fPJIs）相对少见，约占所有假体周围关节感染的 1%。对于真菌感染，通常推荐进行翻修手术；然而，这对患者的身体和经济都会产生重大影响。在本报告中，我们报告了一例 fPJI 患者，通过清创术、抗生素和保留植入物（DAIR）成功治疗，5 年随访结果良好。
一名 56 岁男性患者，在右侧初次全膝关节置换术后 1 周出现手术切口不愈合。
伤口渗液的微生物培养鉴定为近平滑念珠菌。术后，患者血清白蛋白水平显著下降，血糖控制不佳。C 反应蛋白和红细胞沉降率均升高。
进行了全面的 DAIR 手术，并持续使用氟康唑进行封闭冲洗 1 周。患者接受了 4 周的静脉伏立康唑治疗，随后又接受了 3 个月的口服氟康唑治疗。
在 1 年和 5 年的随访中，患者的 C 反应蛋白和红细胞沉降率水平均在正常范围内，右膝关节无肿胀、红斑或触痛，表明无感染迹象。
DAIR 是治疗早期 fPJIs 的有效方法，持续封闭冲洗可能具有特定优势。患者的营养状况在假体周围感染的管理中起着至关重要的作用。
