Successful treatment of Candida albicans-infected total hip prosthesis with staged procedure using an antifungal-loaded cement spacer.
We present a rare case of an immunocompetent host who developed a Candida albicans-infected total hip prosthesis. The infection could not be eradicated with debridement and extensive antifungal therapy. Our patient first underwent a resection of the proximal femur and local treatment with gentamicin-loaded cement beads. In a second procedure, a handmade cement spacer impregnated with voriconazole, amphotericin B, and vancomycin was placed. After 3 months of additional systemic antibiotic therapy, the patient remained afebrile, and a tumor prosthesis was placed. Six years postoperatively, she is doing well, walking with a small limp and no signs of recurrent infection. This is the first report on elution of voriconazole and amphotericin B from bone cement delivered at clinically significant concentrations for at least 72 hours.
Department of Orthopedic Surgery, University Medical Center Groningen, The Netherlands.
Jenneke J
JJ
Deelstra
Danielle
D
Neut
Paul C
PC
Jutte
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements; D016025:Bone Transplantation; D002176:Candida albicans; D002177:Candidiasis / Q000628:therapy*; D003646:Debridement; D020878:Device Removal; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects / Q000382:microbiology; D006801:Humans; D057068:Periprosthetic Fractures / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D012086:Reoperation
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D001843:Bone Cements