Case Report: Candida auris Prosthetic Knee Infection: The First Reported Case in Tunisia

Candida auris (currently also referred to as Candidozyma auris ) is an emerging multidrug-resistant yeast associated with healthcare-associated infections. Its identification and management remain challenging because of its persistence in healthcare environments and its frequent antifungal resistance. We report a case of recurrent periprosthetic knee infection in a 75-year-old Tunisian woman, occurring 14 days after prosthesis reimplantation and associated with multidrug-resistant Enterobacter cloacae and extensive skin loss over the knee. C. auris was isolated from pus and a skin biopsy specimen. Identification was confirmed using the VITEK 2 system and ITS sequencing, which showed 100% identity with a reference sequence of C. auris. To our knowledge, this is the first reported case of C. auris prosthetic knee infection in Tunisia. Antifungal therapy consisted of intravenous voriconazole for one week, followed by intravenous anidulafungin for seven weeks. Management also involved repeated surgical interventions, debridement, negative-pressure wound therapy, external fixation, and hyperbaric oxygen therapy. Despite flap necrosis requiring further intervention, the wound progressively healed. At four months of follow-up, no further prosthetic reimplantation had been performed, and radiographs showed no additional bone lesions. This case highlights the diagnostic and therapeutic challenges of C. auris prosthetic joint infection and the importance of multidisciplinary management.