BACKGROUND Prosthetic joint infection (PJI) caused by Candida spp is a severe complication of arthroplasty. We investigated the outcomes of Candida PJI. METHODS 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. RESULTS 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). CONCLUSIONS 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.

中文翻译：

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念珠菌属引起的人工关节感染：一项多中心国际研究。


背景 念珠菌属引起的人工关节感染 （PJI） 是关节置换术的一种严重并发症。我们调查了 Candida PJI 的结局。方法 这是一项回顾性观察性多国研究，包括 2010 年至 2021 年间诊断为念珠菌相关 PJI 的患者。在 2 年随访时评估治疗结果。结果 共分析 269 例患者。中位年龄为 73.0 岁 （四分位距 [IQR]，64.0-79.0 岁）;46.5% 的患者为男性，10.8% 的患者为免疫抑制。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。外科手术包括清创、抗生素和植入物保留 （DAIR） （35.7%） 、 1 期置换 （28.3%） 和 2 期置换 （29.0%）。鉴定出的念珠菌属为白色念珠菌 （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%）。在 51.3% 的病例中发现细菌混合感染。开具的主要抗真菌药是唑类 （75.8%） 和棘白菌素 （30.9%），中位给药时间为 92.0 （IQR，54.5-181.3） 天。在 269 例病例中，有 156 例 （58.0%） 观察到治愈。治疗失败与年龄 >70 岁 （OR， 1.811 [95% 置信区间 {CI}： 1.079-3.072]） 和 DAIR （OR， 1.946 [95% CI： 1.157-3.285]） 的使用相关。近平滑念珠菌感染与更好的结局相关 （OR， 0.546 [95% CI： .305-.958]）。DAIR 与 1 期交换 （46.9% vs 67.1%，P = .008） 和 DAIR 与 2 期交换 （46.9% vs 69.2%，P = .003） 之间的治愈率存在显著差异，但与 1 期和 2 期交换相比没有差异 （P = .777）。 结论 念珠菌 PJI 预后似乎很差，失败率高，这似乎与免疫抑制、唑类药物的使用或治疗持续时间无关。