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Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes

机译:坎迪达髋关节感染的髋关节感染:对外科治疗和临床结果的系统审查

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Purpose To produce a systematic analysis of types of treatment and outcomes of Candida hip periprosthetic joint infections and their correlation with specific pathogen species. Methods During June 2018, a literature search of candida periprosthetic hip infection in PubMed, Scopus and Embase databases was performed according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used Oxford level of evidence (LoE) and methodological index for non-randomised studies (MINORS) score. Modal distribution of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcomes was calculated through the chi-square test. Results Seventy-nine cases were collected through 35 articles, identifying 81 pathogens. Candida albicans was the most common pathogen. Analysis of LoE reveals 26 LoE 5 (74.29%) and nine LoE 4 (26.71%). From nine LoE 4, ten patients (20.41%) underwent one-stage revision, 22 patients (44.90%) two-stage revision, 11 patients (22.45%) resection arthroplasty and six patients (12.24%) debridement with prosthesis retention. Global success was obtained in 31 cases (63.27%). Modal distribution revealed a preference for two-stage revision (22/49) and fluconazole as medical therapy (36/49). A significant difference was found between one-stage revision and resection arthroplasty (p = 0.031) or debridement (p = 0.003) and between two-stage revision and debridement (p = 0.013). No differences were found between Candida spp. in terms of the outcomes (p = 0.736). Methodological index showed a poor MINOR score. Conclusions Analysis of the literature suggests better clinical outcome with one- or two-stage revision than with resection arthroplasty or debridement, but the level of evidence is low.
机译:目的,制定对念珠菌的治疗和结果类型的系统分析及其与特定病原体物种的相关性。方法在2018年6月期间,根据PRISMA(用于系统评价和META分析的首选报告项目)指导,进行了PUBMED,SCOPUS和EMBASE数据库中的念珠菌患者髋关节感染的文献。审稿人使用牛津的证据(LOE)水平和非随机性研究(未成年人)评分的方法指标。通过Chi-Square试验计算了手术,药理学治疗和结果的模态分布以及治疗类型与结果之间的相关性。结果通过35份物品收集七十九种病例,鉴定81个病原体。念珠菌白醛是最常见的病原体。 LOE分析显示26 LOE 5(74.29%)和九个LOE 4(26.71%)。从九个LOE 4,1患者(20.41%)进行一次阶段修订,22例患者(44.90%)两阶段修订,11名患者(22.45%)切除关节置换术和六名患者(12.24%)的清创,具有假体保留。全球成功在31例(63.27%)中获得。模态分布揭示了两阶段修订(22/49)和氟康唑作为医疗治疗的偏好(36/49)。在一期修订和切除关节置换术(P = 0.031)或清创(P = 0.003)之间以及两级修正和清除之间存在显着差异(P = 0.013)。念珠菌SPP没有发现差异。就结果(p = 0.736)而言。方法论指数显示出较差的小分数。结论文献分析表明,与切除关节成形术或清卓人,但证据水平低。

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