Dinh Aurélien, McNally Martin, D'Anglejan Emma, Mamona Kilu Christel, Lourtet Julie, Ho Rosemary, Scarborough Matthew, Dudareva Maria, Jesuthasan Gerald, Ronde Oustau Cecile, Klein Stéphane, Escolà-Vergé Laura, Rodriguez Pardo Dolores, Delobel Pierre, Lora-Tamayo Jaime, Mancheño-Losa Mikel, Sorlí Redó Maria Luisa, Barbero Allende José María, Arvieux Cédric, Vaznaisiène Danguole, Bauer Thomas, Roux Anne-Laure, Noussair Latifa, Corvec Stéphane, Fernández-Sampedro Marta, Rossi Nicolò, Lemaignen Adrien, Costa Salles Mauro José, Cunha Ribeiro Taiana, Mazet Julien, Sasso Milène, Lavigne Jean-Philippe, Sotto Albert, Canouï Etienne, Senneville Éric, Thill Pauline, Lortholary Olivier, Lanternier Fanny, Morata Laura, Soriano Alex, Giordano Gérard, Fourcade Camille, Frank Bernhard J H, Hofstaetter Jochen G, Duran Clara, Bonnet Eric
Infectious Disease Department, Raymond-Poincaré University Hospital, Paris Saclay University, Assistance Publique-Hôpitaux de Paris, Garches, France.
Oxford Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom.
Clin Infect Dis. 2025 Feb 24;80(2):347-355. doi: 10.1093/cid/ciae395.
Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI.
This was a retrospective observational multinational study including patients diagnosed with Candida-related PJI between 2010 and 2021. Treatment outcome was assessed at 2-year follow-up.
A total of 269 patients were analyzed. Median age was 73.0 (interquartile range [IQR], 64.0-79.0) years; 46.5% of patients were male and 10.8% were immunosuppressed. Main infection sites were hip (53.0%) and knee (43.1%), and 33.8% patients had fistulas. Surgical procedures included debridement, antibiotics, and implant retention (DAIR) (35.7%), 1-stage exchange (28.3%), and 2-stage exchange (29.0%). Candida spp identified were Candida albicans (55.8%), Candida parapsilosis (29.4%), Candida glabrata (7.8%), and Candida tropicalis (5.6%). Coinfection with bacteria was found in 51.3% of cases. The primary antifungal agents prescribed were azoles (75.8%) and echinocandins (30.9%), administered for a median of 92.0 (IQR, 54.5-181.3) days. Cure was observed in 156 of 269 (58.0%) cases. Treatment failure was associated with age >70 years (OR, 1.811 [95% confidence interval {CI}: 1.079-3.072]), and the use of DAIR (OR, 1.946 [95% CI: 1.157-3.285]). Candida parapsilosis infection was associated with better outcome (OR, 0.546 [95% CI: .305-.958]). Cure rates were significantly different between DAIR versus 1-stage exchange (46.9% vs 67.1%, P = .008) and DAIR versus 2-stage exchange (46.9% vs 69.2%, P = .003), but there was no difference comparing 1- to 2-stage exchanges (P = .777).
Candida PJI prognosis seems poor, with high rate of failure, which does not appear to be linked to immunosuppression, use of azoles, or treatment duration.
念珠菌属引起的人工关节感染（PJI）是关节成形术的一种严重并发症。我们研究了念珠菌性PJI的治疗结果。
这是一项回顾性观察性跨国研究，纳入了2010年至2021年间被诊断为念珠菌相关PJI的患者。在2年随访时评估治疗结果。
共分析了269例患者。中位年龄为73.0（四分位间距[IQR]，64.0 - 79.0）岁；46.5%的患者为男性，10.8%的患者存在免疫抑制。主要感染部位为髋关节（53.0%）和膝关节（43.1%），33.8%的患者有瘘管。手术方式包括清创、抗生素及植入物保留（DAIR）（35.7%）、一期翻修（28.3%）和二期翻修（29.0%）。鉴定出的念珠菌属包括白色念珠菌（55.8%）、近平滑念珠菌（29.4%）、光滑念珠菌（7.8%）和热带念珠菌（5.6%）。51.3%的病例合并有细菌感染。开具的主要抗真菌药物为唑类（75.8%）和棘白菌素类（30.9%），中位使用时间为92.0（IQR，54.5 - 181.3）天。269例中有156例（58.0%）治愈。治疗失败与年龄>70岁（比值比[OR]，1.811[95%置信区间{CI}：1.079 - 3.072]）以及使用DAIR（OR，1.946[95%CI：1.157 - 3.285]）有关。近平滑念珠菌感染与较好的预后相关（OR，0.546[95%CI：0.305 - 0.958]）。DAIR与一期翻修的治愈率有显著差异（46.9%对67.1%，P = 0.008），DAIR与二期翻修的治愈率也有显著差异（46.9%对69.2%，P = 0.003），但一期与二期翻修之间无差异（P = 0.777）。
念珠菌性PJI预后似乎较差，失败率较高，这似乎与免疫抑制、唑类药物的使用或治疗持续时间无关。
