Two-stage revision combined with anti-infective therapy for mixed fungal and bacterial knee periprosthetic joint infection: a case report and literature review.

BACKGROUND

Fungal periprosthetic joint infection (PJI) is rare and challenging to manage, particularly when complicated by concurrent bacterial infection. Evidence guiding optimal surgical strategies, the role of antifungal-loaded cement spacers, and the duration of systemic antimicrobial therapy remains limited. CASE PRESENTATION: We report a single case of mixed fungal–bacterial knee PJI in a 61-year-old woman following total knee arthroplasty. Multiple intraoperative cultures yielded Candida parapsilosis and Staphylococcus warneri. The patient was treated using a planned two-stage revision strategy. During the first stage, the prosthesis was removed with extensive debridement, and an articulating polymethylmethacrylate (PMMA) spacer loaded with voriconazole and vancomycin was implanted. Systemic intravenous voriconazole and vancomycin were administered for 10 weeks, followed by oral consolidation therapy to a total duration of 12 weeks. Second-stage revision was performed after clinical resolution, normalization of inflammatory markers, and negative intraoperative cultures.

CONCLUSION

This case suggests that a two-stage revision protocol combined with local antifungal and antibacterial delivery and prolonged systemic therapy can be a feasible management option for mixed fungal–bacterial knee PJI. However, conclusions regarding causality or optimal treatment components cannot be inferred from a single case.