Table 2.
Diagnostic Approaches and Microbiology of Candida Species Causing Candida Osteomyelitis
| No. (%) | |
|---|---|
| Biopsya | |
| Percutaneous/closed/guided biopsy | 76 (37) |
| Open biopsy/surgery | 70 (34) |
| Both percutaneous/closed/guided and open biopsy/surgery | 13 (6) |
| Microbiology/histopathologyb | |
| Direct culture | 154 (74) |
| Histology | 8 (4) |
| Direct culture and histology | 44 (21) |
| Candida spp | |
| C. albicans | 134 (65) |
| C. tropicalis | 33 (16) |
| C. glabrata | 17 (8) |
| C. parapsilosis | 14 (7) |
| C. krusei | 2 (1) |
| C. guilliermondii | 2 (1) |
| Not specified | 13 (6) |
| Otherc | 5 (2) |
| Candida spp recovered by culture per patient | |
| 1 | 197 (95) |
| ≥1 | 10 (5) |
| Bacteria as recovered in cultures mixed with Candida spp | |
| Staphylococcus aureus | 7 (3) |
| Staphylococcus epidermidis | 3 (1) |
| Enterococcus faecalis | 3 (1) |
| Proteus mirabilis | 2 (1) |
| Diphtheroids | 2 (1) |
| Pseudomonas aeruginosa | 1 (0.5) |
| Escherichia coli | 1 (0.5) |
| Eikenella corrodens | 1 (0.5) |
| Lactobacillus spp | 1 (0.5) |
| Streptococcus agalactiae | 1 (0.5) |
| Klebsiella oxytoca | 1 (0.5) |
| Streptococcus salivarius | 1 (0.5) |
| Staphylococcus capitis | 1 (0.5) |
| Other fungi as recovered in cultures mixed with Candida spp | |
| Aspergillus spp | 4 (2) |
a Diagnostic approaches included fine needle aspiration and swab cultures, at ≤10% each. For 9 cases (4%), none of the foregoing methods was provided, and the diagnosis of Candida osteomyelitis was based on a positive blood culture for Candida species in association with radiologically compatible signs of osteomyelitis.
b In addition to direct cultures of bone and surrounding tissue, positive blood cultures for Candida species were present in 31 patients (15%) at the time of diagnosis of Candida osteomyelitis. For 1 case, neither direct culture nor histology was performed, and the diagnosis was based on a positive histopathological result from a previous episode of Candida osteomyelitis.
c Candida dubliniensis, Candida lusitaniae, Candida ciferri, Candida inconspicua, Candida holmii.