Clinical features and outcomes of fungal bone and joint infections in Western France.

BACKGROUND

Fungal bone and joint infections (BJIs) are rare, and their epidemiology and clinical outcomes remain unclear.

METHODS

We conducted a retrospective multicentric cohort study of patients diagnosed with fungal BJIs between 2014 and 2021 in six hospitals in Western France.

RESULTS

We included 103 patients with fungal BJIs : median age was 66 [interquartile range, 51-73] years, 66% (68/103) were male, and 23% (24/103) were immunosuppressed. There were 39% (40/103) implant-associated BJIs. Yeast BJIs represented 81% (83/103) of cases, with Candida albicans (54/83, 65%) being the leading pathogen. Mold BJIs were mostly due to Aspergillus fumigatus (10/20, 50%). Co-infection with bacteria was found in 60% (62/103) of cases. The most frequent surgical procedure was debridement (52/103, 50%). Fluconazole was prescribed for 82% (68/83) of patients with yeast BJIs, whereas voriconazole (16/20, 80%) was mainly used for mold BJIs. Antifungal therapy was administered for a median of 91 [42-180] days. Failure of fungal BJI treatment was observed in 27% (28/103), and two-year all-cause mortality was 21% (22/103). Patients suffered from sequelae in 62% (50/81) with a high rate of disability (38/81, 47%).

CONCLUSIONS

Fungal BJIs represent a wide range of infections associated with a poor prognosis.