Fungal periprosthetic joint infection: Rare but challenging problem.
10.1016/j.cjtee.2021.12.006
- Author:
Emanuele CHISARI
1
;
Feitai LIN
1
;
Jun FEI
2
,
3
;
Javad PARVIZI
4
Author Information
1. Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA.
2. Department of Emergency Medicine of Army Medical Center, Army Medical University, Chongqing, 400042, China
3. State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China.
4. Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, 19107, USA. Electronic address: javadparvizi@gmail.com.
- Publication Type:Review
- Keywords:
Diagnosis and treatment;
Fungi;
Periprosthetic joint infection
- MeSH:
Arthritis, Infectious/etiology*;
Arthroplasty, Replacement, Knee/adverse effects*;
Fungi;
Humans;
Prosthesis-Related Infections/therapy*;
Retrospective Studies
- From:
Chinese Journal of Traumatology
2022;25(2):63-66
- CountryChina
- Language:English
-
Abstract:
Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcusaureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%-2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.
