Risk Factors for Fungal Prosthetic Joint Infection

Key Question

The key question the study aims to address is: What are the risk factors associated with fungal prosthetic joint infections (PJIs)?

Findings

• Forty-one fungal PJIs were identified over the study period.
• 61% of these were due to Candida albicans.
• Fungal PJIs were more likely to occur in patients who:

• • Had received antibiotics within the previous 3 months (70.7% vs 34%, P=.001).
  • Experienced 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).
  • Had a higher proportion of prior two-stage exchanges (82.9% vs 53.6%, P=.008).

• 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

• Candida albicans was the most common species causing fungal PJIs.
• Prolonged wound drainage and recent antibiotic use were identified as independent risk factors for fungal PJIs.
• These findings may help clinicians anticipate the risk of fungal PJIs and adjust management strategies accordingly.

Strengths

• Retrospective case-control study design, which is relatively strong for identifying associations.
• Inclusion of multivariable logistic regression to control for confounding factors.
• Utilized data from two major academic centers, which may improve the generalizability of the findings.

Limitations

• Retrospective nature of the study may introduce biases.
• Small sample size (only 41 fungal PJI cases), which limits the power of the study.
• Lack of long-term follow-up data to assess the outcome of different management strategies.