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Two-stage revision and systemic antifungal therapy of Candida glabrata primary prosthetic hip infection successfully treated: a case report.

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اقرأ أكثر
  • معلومة اضافية
    • المصدر:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101293382 Publication Model: Electronic Cited Medium: Internet ISSN: 1752-1947 (Electronic) Linking ISSN: 17521947 NLM ISO Abbreviation: J Med Case Rep Subsets: MEDLINE
    • بيانات النشر:
      Original Publication: [London] : BioMed Central, [2007-
    • الموضوع:
      Antifungal Agents/*therapeutic use ; Arthroplasty, Replacement, Hip/*adverse effects ; Candidiasis/*diagnosis ; Hip Prosthesis/*microbiology ; Prosthesis-Related Infections/*pathology ; Rectal Fistula/*therapy; Aged ; Anti-Bacterial Agents/therapeutic use ; Candida glabrata/isolation & purification ; Candidiasis/drug therapy ; Humans ; Male ; Micafungin/therapeutic use ; Prosthesis-Related Infections/drug therapy ; Prosthesis-Related Infections/microbiology ; Teicoplanin/therapeutic use ; Treatment Outcome
    • نبذة مختصرة :
      Background: Overall, fungi are estimated to cause approximately 1% of prosthetic joint infections, Candida glabrata account for less than 10% of these cases. No well-defined treatment strategy is available.
      Case Presentation: A 71-year-old Caucasian man with non-insulin-dependent diabetes was admitted for hip prosthesis revision. For the past 17 years he suffered from recurrent infection of a perianal fistula, the last episode being 1 week before admission, and was prescribed amoxicillin/clavulanate 1 g twice a day. At surgery, the synovial fluid tested positive for infection with the Synovasure® Alpha Defensin Test, and the orthopedic surgeon reported intraoperative evidence of infection. While the synovial fluid failed to grow microorganisms, seven different samples including periprosthetic tissue and the prosthesis grew Candida glabrata. Imipenem 2 g and teicoplanin 600 mg daily were administered during surgery. Also an antibiotic loaded spacer was positioned. A week later micafungin 100 mg a day was added, and after another week imipenem was replaced with ertapenem 1 g once a day. The combination of antibiotics and antifungal was administered for a total of 7 weeks, while he also underwent treatment of the perianal fistula. The reimplantation was performed after an 8-week antibiotic-free interval. Before reimplantation, his erythrocyte sedimentation rate and C-reactive protein level were normal. At reimplant surgery, several samples were collected for microbiology, before administering ertapenem 1 g, teicoplanin 600 mg and micafungin 100 mg once a day. This antimicrobial combination was continued for 15 days until the microbiologic investigations, including culture and molecular testing after sonication technique of the spacer, were reported negative for bacteria and fungi. In this patient, systemic antifungal and extensive debridement allowed for clinical and microbiologic cure.
      Conclusions: Although Candida glabrata prosthetic joint infection is a rare event, the incidence could increase in the future, and there is need for more definitive treatment protocols. Diagnosis depends on culture. Fungal etiology must always be included in the differential diagnosis of prosthetic joint infection.
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    • Contributed Indexing:
      Keywords: Candida glabrata; Echinocandin; Prosthetic hip infection; Prosthetic joint infection; Surgery; Therapy
    • الرقم المعرف:
      0 (Anti-Bacterial Agents)
      0 (Antifungal Agents)
      61036-62-2 (Teicoplanin)
      R10H71BSWG (Micafungin)
    • الموضوع:
      Date Created: 20190522 Date Completed: 20191216 Latest Revision: 20200225
    • الموضوع:
      20250114
    • الرقم المعرف:
      PMC6528250
    • الرقم المعرف:
      10.1186/s13256-019-2095-7
    • الرقم المعرف:
      31109363