BACKGROUND: The aim of this study was to analyze the treatment results of fungal periprosthetic joint infections (PJI) caused by Candida species from a single orthopedic center and to compare them with reports from other institutions. METHODS: Eight patients operated on from January 2014 to December 2021 met the inclusion criteria and were analyzed in terms of clinical outcomes. A systematic review of the literature identified 153 patients with Candida PJIs extracted from 12 studies according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: The success rate of the treatment in the case series was 50%. The most frequent pathogens were Candida albicans (three cases; 37.5%) and Candida parapsilosis (three cases; 37.5%). In one patient (12.5%), bacterial co-infection was noted, and in five patients (62.5%) significant risk factors of PJI were confirmed. The overall success rate on the basis of data collected for systematic review was 65.5%. A sub-analysis of 127 patients revealed statistically significant differences (p = 0.02) with a higher success rate for the knees (77.6%) than for the hips (58%). In 10 studies the analysis of risk factors was performed and among 106 patients in 77 (72.6%) comorbidities predispose to fungal PJI were confirmed. Bacterial co-infection was noted in 84 patients (54.9%). In 93 patients (60.7%) Candida albicans was the culprit pathogen, and in 39 patients (25.5%) Candida parapsilosis was the culprit pathogen. Based on these two most frequent Candida species causing PJI, the success rate of the treatment was statistically different (p = 0.03), and was 60.3% and 83.3%, respectively. The two-stage strategy was more favorable for patients with Candida parapsilosis infections (94.4% success rate) than the one-stage protocol (50% success rate; p = 0.02); as well as in comparison to the two-stage treatment of Candida albicans (65% success rate; p = 0.04). CONCLUSIONS: The analysis of the literature showed no differences in the overall success rate between one- and two-stage surgical strategies for all Candida species, but differed significantly comparing the two most frequent strains and concerning PJI localization. The frequent presence of bacterial co-infections makes it necessary to consider the additional administration of antibiotics in the case of fungal PJI.

1st Department of Orthopaedics 1st Faculty of Medicine of Charles University and Motol University Hospital 5 Uvalu 84 15006 Prague Czech Republic

Central Laboratory of Professor Adam Gruca Orthopedic and Trauma Teaching Hospital Konarskiego 13 05 400 Otwock Poland

Department of Anatomical Dissection and Donation Medical University of Lodz Żeligowskiego 7 9 90 752 Lodz Poland

Department of Orthopedics and Rheumoorthopedics Centre of Postgraduate Medical Education Professor Adam Gruca Orthopedic and Trauma Teaching Hospital Konarskiego 13 05 400 Otwock Poland

Department of Spine Diseases and Orthopedics Centre of Postgraduate Medical Education Professor Adam Gruca Orthopedic and Trauma Teaching Hospital Konarskiego 13 05 400 Otwock Poland

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