Successful treatment for acute prosthetic joint infection due to MRSA and Candida albicans: a case report and literature review

Figures & data

Figure 1 (A) The wound of the patient was in a good condition at the third postoperative day; (B) a sterile needle aspiration was performed, with removal of 40 mL of dark bloody fluid at the ninth postoperative day; (C) the yellowish fluid with tofu-like tissue was observed around sinus tract in the knee joint.

Figure 2 (A) The full length plain of lower extremity; (B) the lateral plain of the left knee; (C) the negative plain X-ray of the left knee. (A–C) Severe degenerative arthritis of the left knee with a low patella and bony fusion of femoral condyle. At 5 months of follow-up the radiographs show, (D) the full length plain of lower extremity; (E) the lateral plain of the left knee; (F) the positive film of the left knee. All the film of left knee revealed the prosthesis was well-fixed without loosening.

Table 1 Demographic characteristics, treatment, outcome of patients with MRSA and Candida PJI

Case	Age (years)/gender male	BMI (kg/m^2)	Joint	Sinus tract	Comorbidities	Previous infection in the same site as the PJI	Time to diagnosis from index surgery	No previous surgery	Preoperative microbe	Intravenous agents	Total duration of IV agent	Surgical treatment	Intra- articular injection	Oral agents/mean time (months)	Outcome follow-up time (months)
1^Citation46	88	NR	Hip	Yes	DM, COPD	MRSA, Ser. Marcescens	NR	4	C. albicans	5-FC+Ampho B	NR	OSR	NR	None	No relapse (>36)
2^Citation47	66	27	Hip	NR	COPD	NR	4 months	2	C. parapsilosis, MRSA	FCZ+VAN	31 days	RA	NR	FCZ > 10.2	RA (>28)
3^Citation47	31	27	Hip	NR	DM, RCC, CRI	NR	26 months	1	C. albicans, MRSA	FCZ+VAN	16 days	TSR	NR	FCZ > 0.5	Dead
4^PR	54	26.9	Knee	Yes	None	MRSA	8 days	4	C. albicans	VAN, FCZ	19, 18 days	DAIR	FCZ, then VCZ	VCZ > 1	No relapse (>5)

Abbreviations: MRSA, methicillin-resistant Staphylococcus aureus; PJI, prosthetic joint infection; BMI, body mass index; IV, intravenous; NR, not reported; DM, diabetes mellitus; 5-FC, flucytosine; Ampho B, amphotericin B; OSR, one-stage revision; FCZ, fluconazole; VAN, vancomycin; RA, resection arthroplasty; RCC, renal cell carcinoma; CRI, chronic renal insufficiency; TSR, two-stage revision; PR, present report; DAIR, debridement, antibiotics and implant retention; VCZ, voriconazole.

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