title: Two hundred and eleven cases of Candida osteomyelitis: 17 case reports and a review of the literature.
abstract: Candida osteomyelitis is a rare infection. We present 17 cases of Candida osteomyelitis from our institution and review 194 patients from the literature. The median age of patients was 57 ± 22 years (range, 18-90 years) with 68% male. Comorbidities associated with this infection include prior surgery (62%), broad-spectrum antibiotics (40%), central venous catheter insertion (19%), and immunosuppression (17%). The most common infecting species were Candida albicans (69%), Candida tropicalis (15%), and Candida glabrata (8%). Most initial antifungal regimens included amphotericin B (59%); however, fluconazole is increasingly being utilized for treatment of this infection (26%). Echinocandins were used infrequently (4%). Median length of treatment was 3 ± 4.5 months (mean, 4.2 months; range, 18 days to 36 months). The overall success rate of therapy was 91%, with 75% of patients cured by 6 months. The crude mortality rate was 12% with an attributable mortality rate of 6%.
authors.affiliation: Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA 19107, USA. amy.slenker@jeffersonhospital.org
authors.forename: Amy K
authors.initials: AK
authors.lastname: Slenker
authors.forename: Scott W
authors.initials: SW
authors.lastname: Keith
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D015897:Comorbidity; D054714:Echinocandins / Q000008:administration & dosage; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000666:Amphotericin B; D015725:Fluconazole