Prosthetic Joint Infections due to Candida Species: A Multicenter International Study
Authors: 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 ,   for the European Society of Clinical Microbiology and Infectious Diseases Study Group on Implant Associated Infections (ESGIAI), Bauer Thomas , Courboulès Camille , d’Anglejan Emma , Dinh Aurélien , Duran Clara , Kilu Christel Mamona , Noussair Latifa , Roux Anne-Laure , Bonnet Eric , Fourcade Camille , Giordano Gérard , Dudareva Maria , Ho Rosemary , Jesuthasan Gerald , McNally Martin , Scarborough Matthew , Frank Bernhard J H , Hofstaetter Jochen G , Klein Stephane , Oustau Cecile Ronde , Senneville Éric , Thill Pauline , Escolà-Vergé Laura , Pardo Dolores Rodriguez , Morata Laura , Soriano Alex , Canouï Etienne , Paugam André , Touanga Gertrude , Delobel Pierre , Lora-Tamayo Jaime , Mancheño-Losa Mikel , Lavigne Jean-Philippe , Sasso Milène , Mazet Julien , Sotto Albert , Junyent Juan Gomez , Redó Maria Luisa Sorlí , Costa Salles Mauro José , Ribeiro Taiana Cunha , Allende José Maria Barbero , Desoubeaux Guillaume , Lemaignen Adrien , Porche Chloé , Arvieux Cédric , Méheut Anne , Gangneux Jean-Pierre , Couzigou Carine , Lourtet Julie , Pilmis Benoît , Stucinskas Justinas , Vaznaisiene Danguole , Rossi Nicolò , Corvec Stéphane , Crenn Vincent , Morio Florent , Fernández-Sampedro Marta , Lanternier Fanny , Lortholary Olivier 
Published: August 2024

Abstract

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 &gt;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.