Successful treatment of Candida osteoarticular infections with limited duration of antifungal therapy and orthopedic surgical intervention
Successful treatment of Candida osteoarticular infections with limited duration of antifungal therapy and orthopedic surgical intervention
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DOI：
10.3109/00365548.2014.974207
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发表时间：
2015-03-01
影响因子：
5.8
通讯作者：
Walsh, Thomas J.
中科院分区：
文献类型：
--
作者：
Miller, Andy O.;Gamaletsou, Maria N.;Walsh, Thomas J.
背景资料：目前治疗念珠菌骨关节感染（COAI）的指南建议延长6-12个月的抗真菌治疗（AFT）疗程。根据特殊外科医院（HSS）制定的策略，我们假设抗真菌治疗的持续时间可能会大大减少COAI的管理。方法：这是一个回顾性图表审查的情况下，COAI在HSS治疗过去14年。所有病例均通过开放活检和直接培养证实COAI。记录随访的平均（95%置信区间，CI）持续时间为39（16-61）个月。结果：23例COAI患者中，中位年龄为62岁（范围22-83岁），61%无基础疾病。74%的病例使用了矫形器械，包括关节假体和骨折硬件。所有患者均以COAI作为念珠菌病的第一个确诊部位。白色念珠菌和近平滑念珠菌是最常见的菌种。髋、膝、足、踝是最常见的部位。所有患者均接受了积极的手术干预，随后接受AFT，平均（95% CI）持续时间为45（38-83）天。全身性AFT主要包括氟康唑单用（65%）或与其他药物联合（26%）。35%的患者使用了辅助性术中阿霉素B冲洗。在8例CAOI中，需要放置新的人工关节，所有病例均成功治疗。无微生物失效。结论：假丝酵母菌骨关节感染可以成功地治疗与基本上有限的时间AFT时，结合彻底的手术方法。
Background: Current guidelines for treatment of Candida osteoarticular infections (COAIs) recommend a prolonged course of antifungal therapy (AFT) of 6-12 months. Based upon strategies developed at the Hospital for Special Surgery (HSS), we hypothesized that the duration of antifungal therapy may be substantially reduced for management of COAI. Methods: This was a retrospective chart review of cases of COAI treated at the HSS for the past 14 years. COAI was documented by open biopsy and direct culture in all cases. The mean (95% confidence interval, CI) duration of documented follow-up was 39 (16-61) months. Results: Among the 23 cases of COAI, the median age was 62 years (range 22-83 years) with 61% having no underlying condition. Orthopedic appliances, including joint prostheses and fracture hardware, were present in 74% of cases. All patients had COAI as the first proven site of candidiasis. Candida albicans and Candida parapsilosis were the most common species. Hip, knee, foot, and ankle were the most common sites. All patients received aggressive surgical intervention followed by AFT administered for a mean (95% CI) duration of 45 (38-83) days. Systemic AFT consisted principally of fluconazole alone (65%) or in combination with other agents (26%). Adjunctive intraoperative amphotericin B irrigation was used in 35%. Among eight cases of CAOI that required placement of a new prosthetic joint, all were successfully treated. There were no microbiologic failures. Conclusions: Candida osteoarticular infections may be successfully treated with substantially limited durations of AFT when combined with a thorough surgical approach.