Table 5.
Effect of Age on Effect by Site of Infection, Clinical Manifestations, and Outcome in Candida Osteomyelitis
| Outcome (%) |
|||||||||
|---|---|---|---|---|---|---|---|---|---|
| Populationa (No.) | Mechanism (No.) | Bone Site, Localization (No.) | No. of Sites Infected per Patient (No.) | Clinical Manifestation (No.) | Therapeutic Intervention (No.) | CRb | PR | Rel | D |
| All pediatric patientsc (37) | Hematogenous (29) | Vertebra (3)d | Only AFT (25) | 52 | 24 | 36 | 12 | ||
| Contiguous (5) | Femur (21)e | 1 bone involved (15) | Local symptoms (31)f | Only surgery (1) | 0 | 100 | 0 | 0 | |
| Direct inoculation (3) | Rib (3) | 2 bones involved (8) | Limitation of function/movement (13)g | AFT + surgery (10) | 40 | 10 | 50 | 20 | |
| Sternum (2) | ≥3 bones involved (14) | Fever (12) | Polyenes (22) | 41 | 23 | 41 | 18 | ||
| Humerus (17)h | Draining pus (3) | Azoles (6) | 50 | 17 | 50 | 0 | |||
| Others (19) | Combination AFTi (3) | 100 | 0 | 0 | 0 | ||||
| Adults (164)j,k | Hematogenous (103) | Vertebra (95)d | 1 bone involved (54) | Local symptoms (156)f | Only AFT (61) | 26 | 74 | 15 | 8 |
| Direct inoculation (49) | Femur (7)e | 2 bones involved (88) | Limitation of function/movement (52)g | Only surgery (9) | 56 | 22 | 22 | 22 | |
| Contiguous (12) | Rib (28) | ≥3 bones involved (22) | Fever (53) | AFT + surgery (90) | 29 | 61 | 46 | 7 | |
| Sternum (21) | Draining pus (31) | Polyenes (53) | 25 | 70 | 32 | 15 | |||
| Humerus (0)h | Azoles (44) | 23 | 68 | 32 | 2 | ||||
| Combination AFTi (48) | 33 | 58 | 35 | 4 | |||||
Abbreviations: AFT, antifungal therapy; CI, confidence interval; CR, complete response; D, death; OR, odds ratio; PR, partial response; Rel, relapsed.
a Six cases are not included in this analysis for lack of the age data point.
b Complete response (OR, 0.98; 95% CI, .47–2.0).
c Pediatric patients are defined as age ≤18 years, which also corresponds to the onset of closure of the epiphysis.
d Vertebra (OR, 0.09; 95% CI, .04–.25).
e Femur (OR, 20.6; 95% CI, 8.4–48.1).
f Local symptoms (OR, 0.26; 95% CI, .12–.79).
g Limitations of function or movement (OR, 0.98; 95% CI, .48–2.0).
h Humerus (OR, 46.3; 95% CI, 12.9–169).
i Combination AFT = polyenes + azoles.
j Four adult cases lacked sufficient outcome data.
k Four adult patients received no therapy, and detailed medical treatment data were not available in 2 adult cases.