Scholarlink

Background <p>Fungal periprosthetic joint infection (PJI) is rare and challenging to manage, particularly when complicated by concurrent bacterial infection. Evidence guiding optimal surgical strategies, the role of antifungal-loaded cement spacers, and the duration of systemic antimicrobial therapy remains limited.</p> Case presentation <p>We report a single case of mixed fungal–bacterial knee PJI in a 61-year-old woman following total knee arthroplasty. Multiple intraoperative cultures yielded <i>Candida parapsilosis</i> and <i>Staphylococcus warneri</i>. The patient was treated using a planned two-stage revision strategy. During the first stage, the prosthesis was removed with extensive debridement, and an articulating polymethylmethacrylate (PMMA) spacer loaded with voriconazole and vancomycin was implanted. Systemic intravenous voriconazole and vancomycin were administered for 10 weeks, followed by oral consolidation therapy to a total duration of 12 weeks. Second-stage revision was performed after clinical resolution, normalization of inflammatory markers, and negative intraoperative cultures.</p> Conclusion <p>This case suggests that a two-stage revision protocol combined with local antifungal and antibacterial delivery and prolonged systemic therapy can be a feasible management option for mixed fungal–bacterial knee PJI. However, conclusions regarding causality or optimal treatment components cannot be inferred from a single case.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Two-stage revision combined with anti-infective therapy for mixed fungal and bacterial knee periprosthetic joint infection: a case report and literature review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月20日

查看全文
  • Lin Zhang,
  • Xuxu Yang,
  • Xianpeng Huang,
  • Lidan Yang

摘要

Background

Fungal periprosthetic joint infection (PJI) is rare and challenging to manage, particularly when complicated by concurrent bacterial infection. Evidence guiding optimal surgical strategies, the role of antifungal-loaded cement spacers, and the duration of systemic antimicrobial therapy remains limited.

Case presentation

We report a single case of mixed fungal–bacterial knee PJI in a 61-year-old woman following total knee arthroplasty. Multiple intraoperative cultures yielded Candida parapsilosis and Staphylococcus warneri. The patient was treated using a planned two-stage revision strategy. During the first stage, the prosthesis was removed with extensive debridement, and an articulating polymethylmethacrylate (PMMA) spacer loaded with voriconazole and vancomycin was implanted. Systemic intravenous voriconazole and vancomycin were administered for 10 weeks, followed by oral consolidation therapy to a total duration of 12 weeks. Second-stage revision was performed after clinical resolution, normalization of inflammatory markers, and negative intraoperative cultures.

Conclusion

This case suggests that a two-stage revision protocol combined with local antifungal and antibacterial delivery and prolonged systemic therapy can be a feasible management option for mixed fungal–bacterial knee PJI. However, conclusions regarding causality or optimal treatment components cannot be inferred from a single case.