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Risk Factors for Fungal Prosthetic Joint Infection
Background: Fungal prosthetic joint infections (PJIs) are rare and often associated with poor outcome; however, risk factors are not well described. Methods: This was a retrospective case control study among all patients with PJIs from 2006-2016 at two major academic centers. Each fungal PJI case wa...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Ivyspring International Publisher
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242408/ https://www.ncbi.nlm.nih.gov/pubmed/32454521 http://dx.doi.org/10.7150/jbji.40402 |
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author | Riaz, Talha Tande, Aaron J. Steed, Lisa L. Demos, Harry A. Salgado, Cassandra D. Osmon, Douglas R. Marculescu, Camelia E. |
author_facet | Riaz, Talha Tande, Aaron J. Steed, Lisa L. Demos, Harry A. Salgado, Cassandra D. Osmon, Douglas R. Marculescu, Camelia E. |
author_sort | Riaz, Talha |
collection | PubMed |
description | Background: Fungal prosthetic joint infections (PJIs) are rare and often associated with poor outcome; however, risk factors are not well described. Methods: This was a retrospective case control study among all patients with PJIs from 2006-2016 at two major academic centers. Each fungal PJI case was matched 1:1 with a bacterial PJI control by joint (hip, knee, shoulder) and year of diagnosis. We compared demographics, comorbidities, and clinical characteristics between cases and controls using chi square/Fisher's exact or Wilcoxon rank sum test. Independent risk factors were identified with multivariable logistic regression. Results: Forty-one fungal PJIs occurred over the study and 61% were due to Candida albicans. The hip was involved in 51.2% of cases, followed by the knee (46.3%). Compared to bacterial PJI, fungal PJI cases were more likely to have received antibiotics within the previous 3 months (70.7% vs 34%, P=.001), wound drainage lasting >5 days (48% vs 9%, P=.0002), had a lower median CRP (2.95 mg/dl vs 5.99, P=.013) and synovial fluid white blood cell count (13,953 cells/mm(3) vs 33,198, P=.007), and a higher proportion of prior two-stage exchanges (82.9% vs 53.6%, P=.008). After controlling for center, prolonged wound drainage (OR, 7.3; 95% CI, 2.02-26.95) and recent antibiotics (OR, 3.4; 95% CI, 1.2-9.3) were significantly associated with fungal PJI. Conclusion: In our study, Candida albicans was the most common species in fungal PJIs and prolonged wound drainage and recent antibiotics were independent risk factors. These clinical characteristics may help providers anticipate fungal PJI and adjust management strategies. |
format | Online Article Text |
id | pubmed-7242408 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Ivyspring International Publisher |
record_format | MEDLINE/PubMed |
spelling | pubmed-72424082020-05-22 Risk Factors for Fungal Prosthetic Joint Infection Riaz, Talha Tande, Aaron J. Steed, Lisa L. Demos, Harry A. Salgado, Cassandra D. Osmon, Douglas R. Marculescu, Camelia E. J Bone Jt Infect Research Paper Background: Fungal prosthetic joint infections (PJIs) are rare and often associated with poor outcome; however, risk factors are not well described. Methods: This was a retrospective case control study among all patients with PJIs from 2006-2016 at two major academic centers. Each fungal PJI case was matched 1:1 with a bacterial PJI control by joint (hip, knee, shoulder) and year of diagnosis. We compared demographics, comorbidities, and clinical characteristics between cases and controls using chi square/Fisher's exact or Wilcoxon rank sum test. Independent risk factors were identified with multivariable logistic regression. Results: Forty-one fungal PJIs occurred over the study and 61% were due to Candida albicans. The hip was involved in 51.2% of cases, followed by the knee (46.3%). Compared to bacterial PJI, fungal PJI cases were more likely to have received antibiotics within the previous 3 months (70.7% vs 34%, P=.001), wound drainage lasting >5 days (48% vs 9%, P=.0002), had a lower median CRP (2.95 mg/dl vs 5.99, P=.013) and synovial fluid white blood cell count (13,953 cells/mm(3) vs 33,198, P=.007), and a higher proportion of prior two-stage exchanges (82.9% vs 53.6%, P=.008). After controlling for center, prolonged wound drainage (OR, 7.3; 95% CI, 2.02-26.95) and recent antibiotics (OR, 3.4; 95% CI, 1.2-9.3) were significantly associated with fungal PJI. Conclusion: In our study, Candida albicans was the most common species in fungal PJIs and prolonged wound drainage and recent antibiotics were independent risk factors. These clinical characteristics may help providers anticipate fungal PJI and adjust management strategies. Ivyspring International Publisher 2020-03-26 /pmc/articles/PMC7242408/ /pubmed/32454521 http://dx.doi.org/10.7150/jbji.40402 Text en © The author(s) This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions. |
spellingShingle | Research Paper Riaz, Talha Tande, Aaron J. Steed, Lisa L. Demos, Harry A. Salgado, Cassandra D. Osmon, Douglas R. Marculescu, Camelia E. Risk Factors for Fungal Prosthetic Joint Infection |
title | Risk Factors for Fungal Prosthetic Joint Infection |
title_full | Risk Factors for Fungal Prosthetic Joint Infection |
title_fullStr | Risk Factors for Fungal Prosthetic Joint Infection |
title_full_unstemmed | Risk Factors for Fungal Prosthetic Joint Infection |
title_short | Risk Factors for Fungal Prosthetic Joint Infection |
title_sort | risk factors for fungal prosthetic joint infection |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242408/ https://www.ncbi.nlm.nih.gov/pubmed/32454521 http://dx.doi.org/10.7150/jbji.40402 |
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