Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes.

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Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes.

Int Orthop. 2020 01;44(1):15-22

Authors: Fusini F, Aprato A, Massè A, Bistolfi A, Girardo M, Artiaco S

Abstract
PURPOSE: To produce a systematic analysis of types of treatment and outcomes of Candida hip periprosthetic joint infections and their correlation with specific pathogen species.
METHODS: During June 2018, a literature search of candida periprosthetic hip infection in PubMed, Scopus and Embase databases was performed according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used Oxford level of evidence (LoE) and methodological index for non-randomised studies (MINORS) score. Modal distribution of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcomes was calculated through the chi-square test.
RESULTS: Seventy-nine cases were collected through 35 articles, identifying 81 pathogens. Candida albicans was the most common pathogen. Analysis of LoE reveals 26 LoE 5 (74.29%) and nine LoE 4 (26.71%). From nine  LoE 4, ten patients (20.41%) underwent one-stage revision, 22 patients (44.90%) two-stage revision, 11 patients (22.45%) resection arthroplasty and six patients (12.24%) debridement with prosthesis retention. Global success was obtained in 31 cases (63.27%). Modal distribution revealed a preference for two-stage revision (22/49) and fluconazole as medical therapy (36/49). A significant difference was found between one-stage revision and resection arthroplasty (p = 0.031) or debridement (p = 0.003) and between two-stage revision and debridement (p = 0.013). No differences were found between Candida spp. in terms of the outcomes (p = 0.736). Methodological index showed a poor MINOR score.
CONCLUSIONS: Analysis of the literature suggests better clinical outcome with one- or two-stage revision than with resection arthroplasty or debridement, but the level of evidence is low.

PMID: 31254016 [PubMed - indexed for MEDLINE]