title: Treatment and outcomes of Candida osteomyelitis: review of 53 cases from the PATH Alliance® registry.
abstract: Candida osteomyelitis is associated with significant morbidity; however, data on the management of Candida osteomyelitis are limited. The Prospective Antifungal Therapy (PATH) Alliance® registry is a comprehensive, multicenter, prospective, observational registry that collected data on patients with invasive fungal infections between 2004 and 2008. The aim of this descriptive analysis was to evaluate the clinical characteristics, treatment, and outcomes of patients with Candida osteomyelitis. Using the PATH Alliance® registry, we performed a review of all patients with a proven diagnosis of Candida osteomyelitis who received a minimum of 14 days of antifungal treatment and/or a therapeutic surgical intervention (n = 53). The epidemiology, diagnosis, treatment, and outcomes of these patients were assessed at 12 weeks. C. albicans (56.6 %) was the most commonly identified organism, followed by C. parapsilosis (18.9 %), C. glabrata (9.4 %), and C. tropicalis (9.4 %). The mean treatment duration was 54.9 days. Multiple different treatment regimens were administered to patients. These included fluconazole (56.0 %), echinocandins (29.3 %), amphotericin B formulations (10.7 %), and voriconazole (4.0 %). Twenty-eight patients (52.8 %) also had a therapeutic surgical intervention. Clinical response was improved in 38 (71.7 %) patients (43.4 % complete and 28.3 % partial response), stable in 11 (20.8 %), and worse in one (1.9 %); three (5.7 %) patients had unknown response. The 12-week survival rate was 93.8 %. In summary, C. albicans was the predominant pathogen, and fluconazole was the most commonly administered agent. However, treatment patterns vary and remain non-standardized. Concurrent candidemia was infrequent, and 12-week survival was notably good in this series of 53 patients with Candida osteomyelitis.
authors.affiliation: Transplant and Oncology Infectious Disease Program, Division of Infectious Diseases, The Johns Hopkins University, School of Medicine, 1830 E. Monument Street, Suite 421, Baltimore, MD, 21205, USA, dneofyt1@jhmi.edu.
authors.forename: D
authors.initials: D
authors.lastname: Neofytos
authors.forename: S
authors.initials: S
authors.lastname: Huprikar
authors.forename: A
authors.initials: A
authors.lastname: Reboli
authors.forename: M
authors.initials: M
authors.lastname: Schuster
authors.forename: N
authors.initials: N
authors.lastname: Azie
authors.forename: B
authors.initials: B
authors.lastname: Franks
authors.forename: D
authors.initials: D
authors.lastname: Horn
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D002648:Child; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
references.citation: Clin Infect Dis. 2009 Mar 1;48(5):503-35
references.pmid: 19191635
references.citation: Acta Paediatr. 2006 May;95(5):629-30
references.pmid: 16825152
references.citation: Clin Infect Dis. 2000 Apr;30(4):696-709
references.pmid: 10770732
references.citation: Clin Infect Dis. 2002 Jan 1;34(1):7-14
references.pmid: 11731939
references.citation: Eur J Clin Microbiol Infect Dis. 2007 Dec;26(12):907-14
references.pmid: 17899230
references.citation: Infect Control Hosp Epidemiol. 2005 Jun;26(6):540-7
references.pmid: 16018429
references.citation: Am J Infect Control. 1999 Dec;27(6):520-32
references.pmid: 10586157
references.citation: Clin Infect Dis. 2003 Sep 1;37(5):634-43
references.pmid: 12942393
references.citation: Diagn Microbiol Infect Dis. 2012 May;73(1):89-93
references.pmid: 22578942
references.citation: Clin Infect Dis. 2003 Nov 1;37(9):1172-7
references.pmid: 14557960
references.citation: Clin Infect Dis. 2001 Apr 1;32(7):1110
references.pmid: 11264044
references.citation: Clin Infect Dis. 2005 Apr 15;40(8):1141-7
references.pmid: 15791514
references.citation: Arch Intern Med. 1988 Dec;148(12):2642-5
references.pmid: 3196127
references.citation: Diagn Microbiol Infect Dis. 2012 Aug;73(4):293-300
references.pmid: 22789847
references.citation: Clin Infect Dis. 1998 Oct;27(4):781-8
references.pmid: 9798034
references.citation: Clin Infect Dis. 2005 Nov 1;41(9):1232-9
references.pmid: 16206095
references.citation: Diagn Microbiol Infect Dis. 2007 Dec;59(4):407-14
references.pmid: 17888614
references.citation: Clin Infect Dis. 2012 Nov 15;55(10):1338-51
references.pmid: 22911646
references.citation: J Infect. 2006 Jun;52(6):405-14
references.pmid: 16239033
references.citation: Clin Infect Dis. 2009 Jun 15;48(12):1695-703
references.pmid: 19441981