PDF(Pubmed)
Abstract：
BACKGROUND: Periprosthetic infection is a serious complication after arthroplasty and is characterized by a long duration, recurrence, and a low cure rate. Although fungal infections are infrequent, they are often catastrophic, with an insidious onset, a long duration, atypical clinical symptoms, and imaging features in the early stage. They are easily misdiagnosed, or the diagnosis is missed, resulting in wrong treatment approaches.
METHODS: This paper reports a case involving a 62-year-old female patient of Korean ethnicity with a periprosthetic infection after knee arthroplasty who underwent joint debridement. A preoperative metagenomic next-generation sequencing of joint aspirate revealed Staphylococcus epidermidis. However, postsurgical tissue cultures confirmed the fungal infection. The patient received oral voriconazole and intra-articular injection of voriconazole for antifungal treatment. Since bacterial infection could not be ruled out, we also prescribed levofloxacin. No infection recurrence was observed after more than 22 months of follow-up. In the treatment of this patient, successful short-term follow-up was achieved, but long-term efficacy still cannot be determined.
CONCLUSIONS: In addition to the case study, we provide an analysis of the diagnosis and treatment of fungal infection after arthroplasty, especially the efficacy of debridement, antibiotics, and implant retention for a short-term outcome.
METHODS: This paper reports a case involving a 62-year-old female patient of Korean ethnicity with a periprosthetic infection after knee arthroplasty who underwent joint debridement. A preoperative metagenomic next-generation sequencing of joint aspirate revealed Staphylococcus epidermidis. However, postsurgical tissue cultures confirmed the fungal infection. The patient received oral voriconazole and intra-articular injection of voriconazole for antifungal treatment. Since bacterial infection could not be ruled out, we also prescribed levofloxacin. No infection recurrence was observed after more than 22 months of follow-up. In the treatment of this patient, successful short-term follow-up was achieved, but long-term efficacy still cannot be determined.
CONCLUSIONS: In addition to the case study, we provide an analysis of the diagnosis and treatment of fungal infection after arthroplasty, especially the efficacy of debridement, antibiotics, and implant retention for a short-term outcome.
摘要：
背景：假体周围感染是关节成形术后的严重并发症，其特征是持续时间长，复发,治愈率低。虽然真菌感染很少见，它们往往是灾难性的，有一个阴险的发作，持续时间长,不典型的临床症状，和早期的影像学特征。他们很容易被误诊,或者漏诊,导致错误的治疗方法。
方法：本文报道一例62岁的朝鲜族女性患者膝关节置换术后假体周围感染，进行关节清创。联合抽吸物的术前宏基因组下一代测序显示表皮葡萄球菌。然而,术后组织培养证实真菌感染。患者接受口服伏立康唑和关节内注射伏立康唑用于抗真菌治疗。既然不能排除细菌感染,我们还开了左氧氟沙星.随访22个月以上无感染复发。在这个病人的治疗中,成功的短期随访，但长期疗效仍无法确定。
结论：除了案例研究之外，我们提供了关节置换术后真菌感染的诊断和治疗分析，尤其是清创的功效,抗生素,和植入物保留短期结果。
方法：本文报道一例62岁的朝鲜族女性患者膝关节置换术后假体周围感染，进行关节清创。联合抽吸物的术前宏基因组下一代测序显示表皮葡萄球菌。然而,术后组织培养证实真菌感染。患者接受口服伏立康唑和关节内注射伏立康唑用于抗真菌治疗。既然不能排除细菌感染,我们还开了左氧氟沙星.随访22个月以上无感染复发。在这个病人的治疗中,成功的短期随访，但长期疗效仍无法确定。
结论：除了案例研究之外，我们提供了关节置换术后真菌感染的诊断和治疗分析，尤其是清创的功效,抗生素,和植入物保留短期结果。
