Fungal Periprosthetic Joint Infection

Periprosthetic joint infection (PJI) is the most difficult complication after joint replacement. PJI is a complication that occurs in 0.7–2% of all arthroplasty cases, negatively affecting the quality of life, and sometimes even fatal [1]. The causative bacterial strains (50–60% Staf.aureus and Coagulase-negative staphylococci) were detected in 98% of PJI [2]. Although PJI cases caused by fungi are very rare with 1–2%, there are difficulties in treatment and management due to the lack of a consistent algorithm in the literature [2]. The increasing aging population and the increase in the immunosuppressed population have caused an increase in the incidence of periprosthetic fungal infections over time [3]. Fungal pathogens are mostly seen as causative microorganisms in immunosuppressive hosts, in patients who have received long-term antibiotic therapy, and in patients with a history of multiple surgeries [3]. However, diagnosis of fungal PJI is difficult because may be more difficult compared with bacterial pathogens because of diverse clinical presentations [4]. Surgical and medical management of fungal periprosthetic infections is more difficult than gram-positive or negative infections because these patients are mostly immunosuppressed, and the risk of persistent infection is higher. Although there is increasing interest in the diagnosis and management of bacterial PJI, there is not yet a standard guideline for fungal periprosthetic joint infections [4]. It takes a long time to isolate by traditional culture methods, and some of the culture-negative PJIs are thought to be due to fungi. Many centers often prefer two-stage revision surgery for fungal PJI treatment. However, some fungal strains are quite resistant to treatment and many patients are faced with treatment outcomes leading to arthrodesis, lifelong spacer retention, suppressive medical therapy, and even amputation [5, 6]. In this section, a detailed evaluation given with the current literature on fungal PJI.