, Volume 184, Issue 1, pp 23–33 | Cite as

Prosthetic Joint Infections Caused by Candida Species: A Systematic Review and a Case Series

  • Yoo Ra Lee
  • Hyun Jung Kim
  • Eun Ju Lee
  • Jang Wook Sohn
  • Min Ja Kim
  • Young Kyung YoonEmail author
Original Paper


The purpose of this study was to evaluate the efficacy of echinocandins in the treatment of Candida prosthetic joint infection (PJI) based on published literature and on patients we examined. A structured literature review of multiple databases was conducted to identify patients who received echinocandins for Candida PJIs. Additionally, we describe here the first cases of PJIs due to C. parapsilosis, successfully treated with prolonged anidulafungin therapy. Out of 17 patients, 12 were female and the mean age at diagnosis was 66.0 years. No risk factors associated with Candida PJIs were found in four patients (23.5%). Infection sites included the knee (n = 10, 62.5%), the hip (n = 6, 35.3%) and the shoulder (n = 1, 5.9%). The most frequently isolated Candida species were C. albicans (n = 7, 41.2%) and C. glabrata (n = 7, 41.2%), followed by C. parapsilosis (n = 2, 11.8%) and C. freyschussii (n = 1, 5.9%). All patients were cured with the combination of systemic antifungal therapy and surgical interventions. Two-stage exchange arthroplasty and resection arthroplasty were performed in five and nine patients, respectively. The most frequently used echinocandins were caspofungin (n = 11, 64.7%), followed by anidulafungin (n = 4, 23.5%) and micafungin (n = 2, 11.8%). The median duration (days) of echinocandin therapy was as follows: caspofungin (25.5, range 8–56), micafungin (14.0, range 4–56) and anidulafungin (58, range 14–90). This study supports the effective role of echinocandins, as well as the potential advantage of surgical intervention in the treatment of Candida PJIs. Furthermore, it provides fundamental data on the safety of long-term echinocandin therapy.


Echinocandins Candida Infectious arthritis Prosthesis-related infections 



The authors wish to thank Professor Chang Kyu Lee for his careful review of microbiological data of our manuscript.

Compliance with Ethical Standards

Conflict of interest

None of the authors has any potential financial or non-financial conflicts of interests related to this manuscript.


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Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Division of Infectious Diseases, Department of Internal MedicineKorea University College of MedicineSeoulRepublic of Korea
  2. 2.Institute for Evidence-Based MedicineCochrane KoreaSeoulRepublic of Korea
  3. 3.Department of Preventive MedicineKorea University College of MedicineSeoulRepublic of Korea
  4. 4.Medical LibraryKorea University College of MedicineSeoulRepublic of Korea

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