Fungal periprosthetic joint infection: Rare but challenging problem

• 作者: Chisari Emanuele Lin Feitai Fei Jun Parvizi Javad
• 来源期刊: 中华创伤杂志英文版
• 关键词: Fungi Periprosthetic joint infection Diagnosis and treatment
• 年，卷（期）: 2022,（2）
• 所属期刊栏目: Review Article
• 页码范围: 63-66
• 页数: 4页
• 语种: 中文
• DOI: 10.1016/j.cjtee.2021.12.006

摘要

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 Staphylococcus aureus 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.