title: Fungal Infections of the Spine.
abstract: METHODS
  Review of the literature.
  
  
  OBJECTIVE
  To retrospectively examine the frequency of published fungal infections by species and the treatment algorithms used to eradicate the disease.
  
  
  BACKGROUND
  Fungal infections of the spine present unique challenges to the modern multispecialty treatment team. Although rare in comparison with bacterial infections, fungal infections have been increasing in incidence over the past several decades. Evidences-based practice is limited to referencing smaller case series.
  
  
  METHODS
  MEDLINE, Scopus, and EMBASE searches were carried out by one of the authors as well as by the research desk at the University of Miami/Calder Memorial Library. We included peer-reviewed articles published between 1948 and September 2010; case reports, series, and reviews were all examined and compiled into a database.
  
  
  RESULTS
  A total of 130 articles, representing 157 cases, were included in the review. Aspergillus (60 cases, 38.2% of the total) and Candida species (36 cases, 22.9% of the total) were the 2 most common organisms. Surgery was associated with a greater survival rate than medical management alone in patients with Aspergillus (26.9% mortality in surgical patients; 60% in medically treated patients) and Candida (0% vs. 28.6%). Overall mortality was 19.3%. The overall recurrence rate was 7.4%. Amphotericin use was associated with a higher mortality rate than azoles.
  
  
  CONCLUSIONS
  Aspergillus is the most common published pathogen in fungal infections of the spine. Recent publications depicting the use of newer antifungal medications such as azoles report higher survival rates. Surgically treated patients in combination with antifungal therapy showed highest frequencies of patient survival in Aspergillus and Candida infections.
  
  
  METHODS
  3.
authors: From the *Orlando Health Orthopaedics Department, Orlando, FL †Department of Orthopaedics, University of Miami, Miami, FL ‡University of Miami, Coral Gables, FL.
authors: Devin
authors: D
authors: Ganesh
authors: Jonathan
authors: J
authors: Gottlieb
authors: Sherilynn
authors: S
authors: Chan
authors: Octavio
authors: O
authors: Martinez
authors: Frank
authors: F
authors: Eismont
mesh_terms: D000465:Algorithms; D000935:Antifungal Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D019091:Critical Pathways; D006801:Humans; D015994:Incidence; D008826:Microbial Sensitivity Tests; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D019637:Orthopedic Procedures; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D013122:Spinal Diseases / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents