Abstract
Abstract. Background: Fungal prosthetic joint infections (PJIs) are rare and often associated with poor outcome; however, risk factors are not well described.Methods: This was a retrospective case control study among all patients with PJIs from 2006-2016 at two major academic centers. Each fungal PJI case was matched 1:1 with a bacterial PJI control by joint (hip, knee, shoulder) and year of diagnosis. We compared demographics, comorbidities, and clinical characteristics between cases and controls using chi square/Fisher's exact or Wilcoxon rank sum test. Independent risk factors were identified with multivariable logistic regression.Results: Forty-one fungal PJIs occurred over the study and 61% were due to Candida albicans. The hip was involved in 51.2% of cases, followed by the knee (46.3%). Compared to bacterial PJI, fungal PJI cases were more likely to have received antibiotics within the previous 3 months (70.7% vs 34%, P=.001), wound drainage lasting >5 days (48% vs 9%, P=.0002), had a lower median CRP (2.95 mg/dl vs 5.99, P=.013) and synovial fluid white blood cell count (13,953 cells/mm3 vs 33,198, P=.007), and a higher proportion of prior two-stage exchanges (82.9% vs 53.6%, P=.008). After controlling for center, prolonged wound drainage (OR, 7.3; 95% CI, 2.02-26.95) and recent antibiotics (OR, 3.4; 95% CI, 1.2-9.3) were significantly associated with fungal PJI.Conclusion: In our study, Candida albicans was the most common species in fungal PJIs and prolonged wound drainage and recent antibiotics were independent risk factors. These clinical characteristics may help providers anticipate fungal PJI and adjust management strategies.
Publication
Journal of Bone and Joint Infection
Notes
Key Question
The key question the study aims to address is: What are the risk factors associated with fungal prosthetic joint infections (PJIs)?
Findings
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Forty-one fungal PJIs were identified over the study period.
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61% of these were due to Candida albicans.
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Fungal PJIs were more likely to occur in patients who:
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Had received antibiotics within the previous 3 months (70.7% vs 34%, P=.001).
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Experienced wound drainage lasting >5 days (48% vs 9%, P=.0002).
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Had a lower median CRP (2.95 mg/dl vs 5.99, P=.013) and synovial fluid white blood cell count (13,953 cells/mm³ vs 33,198, P=.007).
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Had a higher proportion of prior two-stage exchanges (82.9% vs 53.6%, P=.008).
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After controlling for the center, prolonged wound drainage (OR, 7.3; 95% CI, 2.02-26.95) and recent antibiotics (OR, 3.4; 95% CI, 1.2-9.3) were significantly associated with fungal PJI.
Clinical Implications
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Candida albicans was the most common species causing fungal PJIs.
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Prolonged wound drainage and recent antibiotic use were identified as independent risk factors for fungal PJIs.
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These findings may help clinicians anticipate the risk of fungal PJIs and adjust management strategies accordingly.
Strengths
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Retrospective case-control study design, which is relatively strong for identifying associations.
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Inclusion of multivariable logistic regression to control for confounding factors.
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Utilized data from two major academic centers, which may improve the generalizability of the findings.
Limitations
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Retrospective nature of the study may introduce biases.
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Small sample size (only 41 fungal PJI cases), which limits the power of the study.
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Lack of long-term follow-up data to assess the outcome of different management strategies.
Citation
1.
Riaz T, Tande AJ, Steed LL, et al. Risk Factors for Fungal Prosthetic Joint Infection. J Bone Joint Infect. 2020;5(2):76-81.