Geographical Differences in the Epidemiology and Treatment of Candida Prosthetic Joint Infections

Abstract Background Management of prosthetic joint infections (PJIs) due to Candida spp. remains challenging and poorly standardized. Epidemiological patterns and therapeutic strategies may vary between centers and countries, potentially reflecting differences in access to antifungal agents. Methods We performed a secondary analysis of an international, multicenter, retrospective study supported by the European Society of Clinical Microbiology and Infectious Diseases, including Candida PJI diagnosed between 2010 and 2020. Cases met European Bone and Joint Infection Society criteria, combining clinical signs of infection with at least 2 intraoperative samples positive for Candida spp. Follow-up was 2 years. Epidemiology, management, and outcomes were compared across 5 groups: France, Spain, England, Austria, and other countries. Results Overall, 268 cases were included: France (n = 142), Spain (n = 42), England (n = 38), Austria (n = 36), and others (Brazil, Lithuania, Italy; n = 9). Distribution of infected sites was similar across countries (hip 53.4%, knee 43.3%, and other 3.3%), as was species epidemiology (Candida albicans 55.6%, Candida parapsilosis 29.5%, Candida glabrata 7.8%, and Candida tropicalis 5.6%). Surgical strategies differed: 1-stage exchange was more frequent in France (36.0%) and Austria (34.3%), whereas 2-stage exchange predominated in England (42.1%) and Spain (37.2%). Echinocandins were prescribed significantly more often in France (41.8%) than elsewhere. Overall outcomes were poor, with a global failure rate of 43%, without significant differences between countries. Conclusions International differences in epidemiology and management of Candida PJI appear limited. Variations in surgical and antifungal strategies did not translate into improved outcomes, highlighting the need for optimized and standardized management approaches in future collaborative prospective studies worldwide and clinical.