Table II.
Candida prosthetic hip infections treated without resection arthroplasty.
| Author, y [Ref.] | Age (y) | Sex | Underlying conditions | Type of infection | Treatment | Outcome |
|---|---|---|---|---|---|---|
| Current report | 93 | F | Chronic obstructive pulmonary disease, coronary artery disease and previous stroke, hypertension, dementia, atrial fi brillation. Pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) 2 months prior | C. albicans prosthetic hip arthritis (2 months after 3 recurrent dislocations of the right hip) | Fluconazole (400 mg i.v./day) for 6 weeks with gradual resolution of all her discomfort followed by oral fl uconazole (400 mg/day) indefi nitely | 10 months after presentation, follow-up X-ray of the right hip revealed well-aligned total hip prosthesis. Repeat erythrocyte sedimentation rate was 60 mm/h and highly sensitive C-reactive protein, 2.2 mg/l. At follow-up after 1 y the patient remained afebrile, did not have recurrent hip pain and did not have any further falls |
| Merrer, 2001 [2] | 81 | F | Diabetes, right hemi-colectomy for colonic carcinoma. Bilateral total hip arthroplasty 12 y prior (indication NR) | C. albicans prosthetic hip arthritis (1 month after right hemicolectomy) | Fluconazole for 10 months (400 mg/day for 3 months and then 200 mg/day for 7 months) | No recurrence of infection 6 months after cessation of fl uconazole therapy. Died of an intestinal haemorrhage 11 months after the end of treatment |
| Cushing, 1997 [3] | 73 | F | Total joint arthroplasty | Candida parapsilosis knee infection 30 months after total joint arthroplasty | Fluconazole 400 mg daily for 6 months, followed by maintenance dose of 100 mg orally daily | No recurrence of infection 1 y after intravenous therapy was initiated |
| Fukasawa, 1997 [4] | 80 | F | Elderly patient with osteoarthritis | Candida parapsilosis arthritis after total knee 2 months after left knee arthroplasty for osteoarthritis. Co-infection with Pseudomonas aeruginosa | Intra-articular fl uconazole. 1 y of oral fl uconazole treatment (200 mg/day). Ceftazidime, clindamycin for 3 weeks then oral norfl oxacin for 2 weeks | Successful treatment without prosthesis removal (2 y follow-up). The fi rst nonimmunocompromised patient who has been cured without removal of the implant |
| Simonian, 1997 [5] | 76 | F | Elderly patient without predisposing medical problems | Candida (species NR) infection of knee 3.5 y after total knee arthroplasty | Treated with only a suppressive dose of ketoconazole (200 mg every day) for 8 months | No recurrence of infection 6 y after the revision surgery |
| White, 1995 [20] | 64 | F | Severe osteoarthritis, total right-knee replacement | Candida parapsilosis prosthetic joint infection 8 months after prosthesis | Fluconazole 200 mg/day for 7 months and 400 mg/day for 17 months. Cultures remained positive for Candida parapsilosis. Removal of the prosthetic device 3 y after total knee replacement combined with a 500-mg course of intravenous amphotericin B; bone cultures again yielded C. parapsilosis. Itraconazole (200 mg twice daily) for 5 months | The fi rst documented failure of fl uconazole in the treatment of candidal prosthetic arthritis despite the apparent in vitro susceptibility of the organism to that drug |
| Tunkel, 1993 [19] | 37 | M | HIV, haemophilia, prior prosthetic joint infections, multiple joint revisions, prolongedantibiotic therapy | Prosthetic knee infection from Candida parapsilosis 4 months after implantation and revision of previous left total knee replacement | Resection arthroplasty; amphotericin B (880 mg), then ketoconazole given daily (400 mg); reimplantation; recurrence while receiving ketoconazole at 1 month; fl uconazole maintenance, 200 mg/day for 6 months; amputation (4 months from resection arthroplasty to reimplantation) | Treatment failure initially (2 months follow-up). The fi rst case of Candida prosthetic arthritis in which mycologic cure was achieved with fl uconazole despite the continued presence of the prosthesis |
NR, not recorded.