Diagnosis and Management of Fungal Periprosthetic Joint Infections
Document Type
Article
Publication Date
12-2018
Abstract
Fungal periprosthetic joint infection (PJI) is a devastating complication because it can be difficult to diagnose, manage, and eradicate. Fungal PJI treatment requires a systematic approach. Increased awareness is essential when patients with painful arthroplasties present with immunosuppression, significant comorbidities, multiple surgeries, and history of drug use. Every suspected fungal PJI should be promptly diagnosed using readily available serum and synovial fluid markers. Surgical management involves débridement, antibiotics, and implant retention, one-stage exchange arthroplasty, prosthetic articulating spacers, and two-stage exchange arthroplasty. Because mycotic infections develop robust biofilms, the utility of débridement, antibiotics, and implant retention and one-stage revisions seem limited. A thorough irrigation and débridement is essential to decrease infection burden. Adjunctive local and systemic antifungal therapy is critical, although the agent choice and duration should be tailored appropriately. Future high-quality studies are needed to develop standardized guidelines for the management of fungal PJI.
Publication Title
Journal of the American Academy of Orthopaedic Surgeons
Recommended Citation
Nace, James; Siddiqi, Ahmed; Talmo, Carl T.; and Chen, Antonia F., "Diagnosis and Management of Fungal Periprosthetic Joint Infections" (2018). Orthopedic Surgery Resident Research. 19.
https://digitalcommons.pcom.edu/orthopedic_surgery_residents/19
PubMed ID
30520804
Comments
This article was published in Journal of the American Academy of Orthopaedic Surgeons.
The published version is available at https://doi.org/10.5435/JAAOS-D-18-00331.
Copyright © 2018 American Academy of Orthopaedic Surgeons.