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Abstract：
UNASSIGNED: There has been limited literature synthesizing the therapeutic effects of surgical procedures for fungal periprosthetic joint infection (PJI) following hip arthroplasty. The authors\' current study aims to comprehensively review and analyze those relevant literature, and carefully make recommendations for future clinical practices.
UNASSIGNED: Our current study was carried out in accordance with the PRISMA 2020 statement. Studies regarding the surgical management of fungal PJI following hip arthroplasty were collected via a thorough search of PubMed, Embase and Google scholar databases. The search was lastly performed in March 2023. Non-English language, reviews, articles with duplicated data, and articles without clear information about the type of fungal pathogens and treatment options were excluded. The authors evaluated their systematic review compliance by using AMSTAR 2 criteria and fell in moderate quality. Clinical outcomes of different surgical procedures were evaluated, and a binary logistic regression model was used to identify the risks associated with treatment failure. Data analyses were performed using the SPSS version 19.0.
UNASSIGNED: A total of 33 articles encompassing 80 patients with fungal PJI following hip arthroplasty were identified. Candida albicans was the most frequently isolated fungus (56.3%, 45/80). The overall treatment success was achieved in 71.1% (54/76) of the reported cases. Univariate analysis showed that the differences of success rate were not significant between publication periods, genders, ages, specimen collection methods, and fungal pathogens. Treatment success rate was 47.4% (9/19) in fungal PJI cases with bacterial co-infection, significantly lower than those without [vs. 79.0% (45/57), P=0.017]. The pooled success rate for surgical debridement, spacer implantation, resection arthroplasty, one-stage revision, and two-stage revision was 50.0% (4/8), 42.9% (3/7), 55.0% (11/20), 86.7% (13/15), and 88.5% (23/26), respectively, with significant differences between them (P=0.009). A binary logistic regression model showed that bacterial co-infection and surgical option were the two significant risk factors associated with treatment failure for fungal PJI following hip arthroplasty.
UNASSIGNED: Regarding the surgical treatment of fungal PJI following hip arthroplasty, patients with bacterial co-infection, and those treated with surgical procedures such as debridement, spacer implantation, and resection arthroplasty should be aware of the higher risks of failure. Nonetheless, future multiple-centre cohort studies are required to establish the optimal treatment.
UNASSIGNED: Our current study was carried out in accordance with the PRISMA 2020 statement. Studies regarding the surgical management of fungal PJI following hip arthroplasty were collected via a thorough search of PubMed, Embase and Google scholar databases. The search was lastly performed in March 2023. Non-English language, reviews, articles with duplicated data, and articles without clear information about the type of fungal pathogens and treatment options were excluded. The authors evaluated their systematic review compliance by using AMSTAR 2 criteria and fell in moderate quality. Clinical outcomes of different surgical procedures were evaluated, and a binary logistic regression model was used to identify the risks associated with treatment failure. Data analyses were performed using the SPSS version 19.0.
UNASSIGNED: A total of 33 articles encompassing 80 patients with fungal PJI following hip arthroplasty were identified. Candida albicans was the most frequently isolated fungus (56.3%, 45/80). The overall treatment success was achieved in 71.1% (54/76) of the reported cases. Univariate analysis showed that the differences of success rate were not significant between publication periods, genders, ages, specimen collection methods, and fungal pathogens. Treatment success rate was 47.4% (9/19) in fungal PJI cases with bacterial co-infection, significantly lower than those without [vs. 79.0% (45/57), P=0.017]. The pooled success rate for surgical debridement, spacer implantation, resection arthroplasty, one-stage revision, and two-stage revision was 50.0% (4/8), 42.9% (3/7), 55.0% (11/20), 86.7% (13/15), and 88.5% (23/26), respectively, with significant differences between them (P=0.009). A binary logistic regression model showed that bacterial co-infection and surgical option were the two significant risk factors associated with treatment failure for fungal PJI following hip arthroplasty.
UNASSIGNED: Regarding the surgical treatment of fungal PJI following hip arthroplasty, patients with bacterial co-infection, and those treated with surgical procedures such as debridement, spacer implantation, and resection arthroplasty should be aware of the higher risks of failure. Nonetheless, future multiple-centre cohort studies are required to establish the optimal treatment.
摘要：
有有限的文献综合了髋关节置换术后真菌性假体周围关节感染（PJI）的外科手术治疗效果。作者目前的研究旨在全面回顾和分析这些相关文献，并仔细为今后的临床实践提出建议。
■我们目前的研究是根据PRISMA2020声明进行的。通过彻底搜索PubMed收集了有关髋关节置换术后真菌性PJI手术治疗的研究，Embase和谷歌学者数据库。最后一次搜索是在2023年3月进行的。非英语语言，reviews,具有重复数据的文章，和文章没有明确信息的真菌病原体的类型和治疗方案被排除。作者使用AMSTAR2标准评估了他们的系统评价依从性，质量中等。评估不同手术方式的临床结果，并使用二元逻辑回归模型来识别与治疗失败相关的风险。使用SPSS版本19.0进行数据分析。
■共发现33篇文章，其中包括80例髋关节置换术后的真菌性PJI患者。白色念珠菌是最常见的真菌(56.3%，45/80)。71.1%(54/76)的报告病例获得了总体治疗成功。单因素分析显示,各发表期成功率差异不显著,性别,年龄,标本采集方法,和真菌病原体。真菌PJI合并细菌感染的治疗成功率为47.4%(9/19),明显低于没有[vs.79.0%（45/57），P=0.017]。合并手术清创成功率，垫片植入,关节切除术,一阶段修订，两阶段修订为50.0%(4/8)，42.9%（3/7），55.0%（11/20），86.7%（13/15），和88.5%(23/26)，分别,差异有统计学意义(P=0.009)。二元logistic回归模型显示，细菌合并感染和手术选择是髋关节置换术后真菌PJI治疗失败的两个重要危险因素。
■关于髋关节置换术后真菌性PJI的手术治疗，合并细菌感染的患者，以及那些接受手术如清创术治疗的患者，垫片植入,和关节切除术应该意识到更高的失败风险。尽管如此，未来的多中心队列研究需要确定最佳治疗方案.
■我们目前的研究是根据PRISMA2020声明进行的。通过彻底搜索PubMed收集了有关髋关节置换术后真菌性PJI手术治疗的研究，Embase和谷歌学者数据库。最后一次搜索是在2023年3月进行的。非英语语言，reviews,具有重复数据的文章，和文章没有明确信息的真菌病原体的类型和治疗方案被排除。作者使用AMSTAR2标准评估了他们的系统评价依从性，质量中等。评估不同手术方式的临床结果，并使用二元逻辑回归模型来识别与治疗失败相关的风险。使用SPSS版本19.0进行数据分析。
■共发现33篇文章，其中包括80例髋关节置换术后的真菌性PJI患者。白色念珠菌是最常见的真菌(56.3%，45/80)。71.1%(54/76)的报告病例获得了总体治疗成功。单因素分析显示,各发表期成功率差异不显著,性别,年龄,标本采集方法,和真菌病原体。真菌PJI合并细菌感染的治疗成功率为47.4%(9/19),明显低于没有[vs.79.0%（45/57），P=0.017]。合并手术清创成功率，垫片植入,关节切除术,一阶段修订，两阶段修订为50.0%(4/8)，42.9%（3/7），55.0%（11/20），86.7%（13/15），和88.5%(23/26)，分别,差异有统计学意义(P=0.009)。二元logistic回归模型显示，细菌合并感染和手术选择是髋关节置换术后真菌PJI治疗失败的两个重要危险因素。
■关于髋关节置换术后真菌性PJI的手术治疗，合并细菌感染的患者，以及那些接受手术如清创术治疗的患者，垫片植入,和关节切除术应该意识到更高的失败风险。尽管如此，未来的多中心队列研究需要确定最佳治疗方案.
