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

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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.

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