Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2019; 7(12): 1430-1443
Published online Jun 26, 2019. doi: 10.12998/wjcc.v7.i12.1430
Non-albicans Candida prosthetic joint infections: A systematic review of treatment
Christos Koutserimpas, Stylianos G Zervakis, Sofia Maraki, Kalliopi Alpantaki, Argyrios Ioannidis, Diamantis P Kofteridis, George Samonis
Christos Koutserimpas, Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Athens 11525, Greece
Stylianos G Zervakis, Diamantis P Kofteridis, George Samonis, Department of Internal Medicine, University Hospital of Heraklion, Crete, Heraklion 71110, Greece
Sofia Maraki, Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Heraklion 71110, Greece
Kalliopi Alpantaki, Department of Materials Science and Technology, University of Crete, Heraklion, Heraklion 71110, Greece
Argyrios Ioannidis, Department of General Surgery, “Sismanoglion” General Hospital of Athens, Athens 15126, Greece
Author contributions: Koutserimpas C, Zervakis SG, Alpantaki K and Samonis G designed the research; Zervakis SG, Maraki S and Kofteridis DP performed the research; Koutserimpas C and Ioannidis A contributed new reagents/analytic tools; Koutserimpas C and Ioannidis A analyzed the data; Koutserimpas C, Zervakis SG, Alpantaki K and Samonis G wrote the paper.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: PRISMA 2009 Checklist statement is provided.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christos Koutserimpas, MD, Doctor, Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, P. Kanellopoulou Av., Athens 11525, Greece. chrisku91@hotmail.com
Telephone: +30-694-8712130
Received: January 22, 2019
Peer-review started: January 23, 2019
First decision: March 10, 2019
Revised: March 16, 2019
Accepted: April 19, 2019
Article in press: April 19,2019
Published online: June 26, 2019
Abstract
BACKGROUND

Non-albicans Candida prosthetic joint infections (PJIs) are rare. Optimal treatment involves a two-stage revision surgery in combination with an antifungal agent. However, no clear guidelines have been developed regarding the agent or treatment duration. Hence, a broad range of antifungal and surgical treatments have been reported so far.

AIM

To clarify treatment of non-albicans Candida PJIs.

METHODS

A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. Information was extracted about demographics, comorbidities, responsible species, duration and type of antifungal treatment, type of surgical treatment, time between initial arthroplasty and symptom onset, time between symptom onset and definite diagnosis, outcome of the infection and follow-up.

RESULTS

A total of 83 cases, with a mean age of 66.3 years, were located. The causative yeast isolated in most cases was C. parapsilosis (45 cases; 54.2%), followed by C. glabrata (18 cases; 21.7%). The mean Charlson comorbidity index was 4.4 ± 1.5. The mean time from arthropalsty to symptom onset was 27.2 ± 43 mo, while the mean time from symptom onset to culture-confirmed diagnosis was 7.5 ± 12.5 mo. A two stage revision arthroplasty (TSRA), when compared to one stage revision arthroplasty, had a higher success rate (96% vs 73%, P = 0.023). Fluconazole was the preferred antifungal agent (59; 71%), followed by amphotericin B (41; 49.4%).

CONCLUSION

The combination of TSRA and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.

Keywords: Fungal prosthetic joint infection, Knee arthroplasty infection, Hip arthroplasty infection, Antifungal treatment, Non-albicans Candida prosthetic joint infections

Core tip: Non-albicans Candida prosthetic joint infections (PJIs) are rare, and no clear guidelines exist regarding the treatment of these infections. The purpose of this study was to clarify, by reviewing current published cases, the treatment options of non-albicans Candida PJIs and, possibly, to improve the medical and surgical care of such cases. A literature review of all existing non-albicans Candida PJIs cases through April 2018 was conducted. The combination of two stage revision arthroplasty and administration of prolonged antifungal therapy after initial resection arthroplasty is suggested on the basis of limited data.