Fungal periprosthetic joint infection: Rare but challenging problem.
10.1016/j.cjtee.2021.12.006
- VernacularTitle:Fungal periprosthetic joint infection: Rare but challenging problem
- Author:
Emanuele CHISARI
1
;
Feitai LIN
1
;
Jun FEI
2
;
Javad PARVIZI
3
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; State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, 400042, China.
3. 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.
