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Microorganisms
Volume 11
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10.3390/microorganisms11010084
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Review

Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature

by
Andrea Sambri
1,
Renato Zunarelli
1,
Michele Fiore
1,*,
Marta Bortoli
1,
Azzurra Paolucci
1,
Matteo Filippini
1,
Eleonora Zamparini
2,
Sara Tedeschi
2,
Pierluigi Viale
2 and
Massimiliano De Paolis
1
1
Orthopaedic Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
2
Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
*
Author to whom correspondence should be addressed.
Microorganisms 2023, 11(1), 84; https://doi.org/10.3390/microorganisms11010084
Submission received: 27 October 2022 / Revised: 15 December 2022 / Accepted: 24 December 2022 / Published: 28 December 2022
(This article belongs to the Special Issue Prosthetic and Bone Infections: A Multidisciplinary Approach)
Versions Notes

Abstract

Fungal prosthetic joint infection (fPJI) is a rare complication; nonetheless, it represents a significant diagnostic and therapeutic challenge. There are no official guidelines on the most effective approach to identify and treat fPJIs. This systematic review aims to review the current literature on fPJI management and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Studies eligible for this systematic review were identified through an electronic systematic search of PubMed, Scopus, and Web of Science until 30 September 2022. Further references were obtained by cross-referencing. Sixty-three studies met the inclusion criteria, reporting on 372 cases of fPJI; such cases were described mostly in case reports and small case series with only a few larger cohort studies. Diagnosis of fPJI is challenging because of its chronic and indolent clinical course; it is further complicated by the technical difficulty of harvesting fungal cultures. A two-stage revision was the primary procedure in 239 (64.2%) patients whereas DAIR and one-stage approaches were reported in 30 (8.0%) and 18 (4.8 %) cases. In conclusion, our study highlights the heterogeneity of the reported treatments of fPJI, particularly in terms of medical management. With concern to a surgical approach, a two-stage revision arthroplasty is generally suggested, considering fPJI a delayed or late infection. The need for multicenter, prospective studies to provide standardized protocols and improve the treatment of fungal PJI clearly emerges.
Keywords: fungal; prosthetic joint infection; two-stage; one-stage; hip; knee fungal; prosthetic joint infection; two-stage; one-stage; hip; knee

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MDPI and ACS Style

Sambri, A.; Zunarelli, R.; Fiore, M.; Bortoli, M.; Paolucci, A.; Filippini, M.; Zamparini, E.; Tedeschi, S.; Viale, P.; De Paolis, M. Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms 2023, 11, 84. https://doi.org/10.3390/microorganisms11010084

AMA Style

Sambri A, Zunarelli R, Fiore M, Bortoli M, Paolucci A, Filippini M, Zamparini E, Tedeschi S, Viale P, De Paolis M. Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms. 2023; 11(1):84. https://doi.org/10.3390/microorganisms11010084

Chicago/Turabian Style

Sambri, Andrea, Renato Zunarelli, Michele Fiore, Marta Bortoli, Azzurra Paolucci, Matteo Filippini, Eleonora Zamparini, Sara Tedeschi, Pierluigi Viale, and Massimiliano De Paolis. 2023. "Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature" Microorganisms 11, no. 1: 84. https://doi.org/10.3390/microorganisms11010084

APA Style

Sambri, A., Zunarelli, R., Fiore, M., Bortoli, M., Paolucci, A., Filippini, M., Zamparini, E., Tedeschi, S., Viale, P., & De Paolis, M. (2023). Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms, 11(1), 84. https://doi.org/10.3390/microorganisms11010084

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