title: May one-stage exchange for Candida albicans peri-prosthetic infection be successful?
abstract: Fungal infection of a total joint arthroplasty has a low incidence but is generally considered as more difficult to cure than bacterial infection. As for bacterial infection, two-stage exchange is considered as the gold standard of treatment. We report two cases of one-stage total joint exchange for fungal peri-prosthetic infection with Candida albicans, where the responsible pathogens was only identified on intraoperative samples. This situation can be considered as a one-stage exchange for fungal peri-prosthetic infection without preoperative identification of the responsible organism, which is considered as having a poor prognosis. Both cases were free of infection after two years. One-stage revision has several potential advantages over two-stage revision, including shorter hospital stay and rehabilitation, no interim period with significant functional impairment, shorter antibiotic treatment, better functional outcome and probably lower costs. We suggest that one-stage revision for C. albicans peri-prosthetic infection may be successful even without preoperative fungal identification.
  
  
  METHODS
  Level IV-Historical cases.
authors.affiliation: University Hospital Strasbourg, CCOM, 10, avenue Baumann, 67400 Illkirch, France. Electronic address: jean-yves.jenny@chru-strasbourg.fr.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Jenny
authors.affiliation: University Hospital Strasbourg, CCOM, 10, avenue Baumann, 67400 Illkirch, France.
authors.forename: O
authors.initials: O
authors.lastname: Goukodadja
authors.affiliation: University Hospital Strasbourg, CCOM, 10, avenue Baumann, 67400 Illkirch, France.
authors.forename: C
authors.initials: C
authors.lastname: Boeri
authors.affiliation: University Hospital Strasbourg, CCOM, 10, avenue Baumann, 67400 Illkirch, France.
authors.forename: J
authors.initials: J
authors.lastname: Gaudias
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D002176:Candida albicans; D002177:Candidiasis / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation
chemical_list: D000935:Antifungal Agents
keywords: Candida albicans; Fungal infection; One-stage exchange; Peri-prosthetic infection