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Candida PJI Management — SCE Infectious Diseases MCQ

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HardFungal InfectionsCandida PJI ManagementSCE Infectious Diseases

Multiple deep samples at revision arthroplasty grow Candida albicans in a patient with chronic prosthetic-hip infection. Which management strategy offers the best prospect of cure?

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Correct answer: C — Staged prosthesis removal plus prolonged systemic antifungal therapy

The best answer is “Staged prosthesis removal plus prolonged systemic antifungal therapy”. Candida prosthetic-joint infection is a biofilm infection with poor outcomes after implant retention; staged removal plus prolonged active antifungal treatment is generally required. Deep Candida infection requires species identification, susceptibility-guided systemic therapy and source control, with prosthetic-joint infection usually needing implant removal. Deep surgical infection needs microbiological diagnosis and source control; retained necrotic tissue or infected prosthetic material limits antimicrobial cure.

Reference: ESCMID Candida guideline: https://pubmed.ncbi.nlm.nih.gov/23137135/ NICE NG125: surgical site infections: https://www.nice.org.uk/guidance/ng125/chapter/Recommendations