{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:19:46Z","timestamp":1792441186144,"version":"4.5.0"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T00:00:00Z","timestamp":1735776000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wroc\u0142aw University of Science and Technology"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Fungal periprosthetic joint infections (PJIs) are rare but increasingly recognized complications following total joint arthroplasty (TJA). While Candida albicans remains the most common pathogen, non-albicans Candida species and other fungi, such as Aspergillus, have gained prominence. These infections often present with subtle clinical features and affect patients with significant comorbidities or immunosuppression. Compared to bacterial PJIs, fungal infections pose unique diagnostic and therapeutic challenges, including biofilm formation, limited antifungal susceptibility, and protracted treatment courses. This narrative review synthesizes current evidence from research articles and review\/metanalysis papers, focusing on fungal PJIs. The literature search encompassed publications from 2015 to 2024, identifying key insights on epidemiology, risk factors, microbiological profiles, diagnostic methods, therapeutic strategies, and outcomes. Both classical references and recent studies addressing emerging diagnostic biomarkers and biofilm-active therapies were included. It was shown that C. albicans remains the primary fungal pathogen in PJIs but non-albicans Candida species and other fungi are associated with more complex clinical scenarios, higher recurrence rates, and reduced infection-free survival. Patients commonly exhibit multiple comorbidities, compromised immune status, and previous prosthetic revisions. Diagnosis is complicated by slow-growing organisms and nonspecific inflammatory markers, prompting interest in novel diagnostics such as alpha-defensin, calprotectin, and next-generation sequencing. Two-stage revision arthroplasty, supplemented by prolonged targeted antifungal therapy, is considered the gold standard for chronic infections, although outcomes remain inferior to bacterial PJIs. Emerging strategies, including antifungal-impregnated beads and biofilm-disrupting agents, may improve local infection control. In conclusion, fungal PJIs constitute a challenging clinical entity demanding tailored diagnostic and therapeutic approaches. Further research into standardized diagnostic criteria, optimized antifungal regimens, biomarker validation, and refined surgical strategies is essential. Multidisciplinary collaboration, enhanced patient optimization, and innovative biofilm-directed therapies hold promise for improving outcomes and reducing the burden of fungal PJIs.<\/jats:p>","DOI":"10.3390\/jcm14010206","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T06:05:10Z","timestamp":1735797910000},"page":"206","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A Narrative Review of Fungal Periprosthetic Joint Infections of the Hip and Knee: Risk Factors, Microbiological Profiles, and Treatment Challenges"],"prefix":"10.3390","volume":"14","author":[{"given":"Wojciech","family":"Sznajder","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Jankowska-Pola\u0144ska","sequence":"additional","affiliation":[{"name":"Centre for Research and Innovation, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Ta\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland"},{"name":"Faculty of Medicine, Wroc\u0142aw University of Science and Technology, 50-376 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.idc.2024.07.007","article-title":"Periprosthetic Joint Infection: What\u2019s New?","volume":"38","author":"Tabaja","year":"2024","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.cjtee.2021.12.006","article-title":"Fungal Periprosthetic Joint Infection: Rare but Challenging Problem","volume":"25","author":"Chisari","year":"2022","journal-title":"Chin. J. Traumatol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Fr\u00f6schen, F.S., Randau, T.M., Franz, A., Molitor, E., and Hischebeth, G.T.R. (2022). Microbiological Profiles of Patients with Periprosthetic Joint Infection of the Hip or Knee. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071654"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"366","DOI":"10.23736\/S0394-9508.23.05652-8","article-title":"Periprosthetic Joint Infection: Current Concepts","volume":"36","author":"Tortia","year":"2023","journal-title":"Chirurgia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.12998\/wjcc.v7.i12.1430","article-title":"non-albicans Candida Prosthetic Joint Infections: A Systematic Review of Treatment","volume":"7","author":"Koutserimpas","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Grzelecki, D., Grajek, A., Dudek, P., Olewnik, \u0141., Zielinska, N., Fulin, P., Czubak-Wrzosek, M., Tyrakowski, M., Marczak, D., and Kowalczewski, J. (2022). Periprosthetic Joint Infections Caused by Candida Species\u2014A Single-Center Experience and Systematic Review of the Literature. J. Fungi, 8.","DOI":"10.3390\/jof8080797"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Benito, N., Mur, I., Ribera, A., Soriano, A., Rodr\u00edguez-Pardo, D., Sorl\u00ed, L., Cobo, J., Fern\u00e1ndez-Sampedro, M., del Toro, M.D., and Gu\u00edo, L. (2019). The Different Microbial Etiology of Prosthetic Joint Infections According to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050673"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sambri, A., Zunarelli, R., Fiore, M., Bortoli, M., Paolucci, A., Filippini, M., Zamparini, E., Tedeschi, S., Viale, P., and De Paolis, M. (2022). Epidemiology of Fungal Periprosthetic Joint Infection: A Systematic Review of the Literature. Microorganisms, 11.","DOI":"10.3390\/microorganisms11010084"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Seyoum, E., Bitew, A., and Mihret, A. (2020). Distribution of Candida albicans and non-albicans Candida Species Isolated in Different Clinical Samples and Their in Vitro Antifungal Suscetibity Profile in Ethiopia. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-4883-5"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"G\u00f3mez-Gaviria, M., Ram\u00edrez-Sotelo, U., and Mora-Montes, H.M. (2022). non-albicans Candida Species: Immune Response, Evasion Mechanisms, and New Plant-Derived Alternative Therapies. J. Fungi, 9.","DOI":"10.3390\/jof9010011"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Giovanoulis, V., Pastamentzas, V., Veizi, E., Matzaroglou, C., Naoum, S., Samonis, G., Piagkou, M., Papadopoulos, D.V., Tsantes, A.G., and Koutserimpas, C. (2024). Fungal Shoulder Periprosthetic Infections: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206128"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1007\/s40121-024-00964-9","article-title":"Fungal Prosthetic Joint Infection: A Case Series and Review of the Literature","volume":"13","author":"Starnes","year":"2024","journal-title":"Infect. Dis. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.artd.2021.02.009","article-title":"Eradicating Fungal Periprosthetic TKA \u201cSuper-Infection\u201d: Review of the Contemporary Literature and Consideration of Antibiotic-Impregnated Dissolving Calcium Sulfate Beads as a Novel PJI Treatment Adjunct","volume":"8","author":"Kurmis","year":"2021","journal-title":"Arthroplast. Today"},{"key":"ref_14","first-page":"114","article-title":"Periprosthetic Knee Infection: Two Stage Revision Surgery","volume":"88","author":"Bonanzinga","year":"2017","journal-title":"Acta Biomed."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1016\/j.arth.2023.05.009","article-title":"Treatment Outcomes of Fungal Periprosthetic Joint Infection","volume":"38","author":"Herndon","year":"2023","journal-title":"J. Arthroplasty"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1128\/CMR.00091-13","article-title":"Molecular and Nonmolecular Diagnostic Methods for Invasive Fungal Infections","volume":"27","author":"Arvanitis","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Shrestha, L., Fan, H.-M., Tao, H.-R., and Huang, J.-D. (2022). Recent Strategies to Combat Biofilms Using Antimicrobial Agents and Therapeutic Approaches. Pathogens, 11.","DOI":"10.3390\/pathogens11030292"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1016\/j.arth.2020.11.005","article-title":"Fungal Periprosthetic Joint Infection: A Review of Demographics and Management","volume":"36","author":"Gross","year":"2021","journal-title":"J. Arthroplasty"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5549","DOI":"10.12659\/MSM.909168","article-title":"Success Rate of Fungal Peri-Prosthetic Joint Infection Treated by 2-Stage Revision and Potential Risk Factors of Treatment Failure: A Retrospective Study","volume":"24","author":"Gao","year":"2018","journal-title":"Med. Sci. Monit."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s00264-021-05214-y","article-title":"Candida Periprosthetic Joint Infections\u2014Risk Factors and Outcome between Albicans and Non-Albicans Strains","volume":"46","author":"Karczewski","year":"2022","journal-title":"Int. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s43019-021-00113-3","article-title":"Clinical Outcomes of Two-Stage Revision Total Knee Arthroplasty in Infected Cases with Antibiotic-Loaded Cement Spacers Produced Using a Handmade Silicone Mold","volume":"33","author":"Hoshino","year":"2021","journal-title":"Knee Surg. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"559","DOI":"10.5312\/wjo.v11.i12.559","article-title":"Systematic Review of Single Stage Revision for Prosthetic Joint Infection","volume":"11","author":"Lum","year":"2020","journal-title":"World J. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Schindler, M., Walter, N., Maderbacher, G., Sigmund, I.K., Alt, V., and Rupp, M. (2023). Novel Diagnostic Markers for Periprosthetic Joint Infection: A Systematic Review. Front. Cell. Infect. Microbiol., 13.","DOI":"10.3389\/fcimb.2023.1210345"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Koutserimpas, C., Naoum, S., Giovanoulis, V., Raptis, K., Alpantaki, K., Dretakis, K., Vrioni, G., and Samonis, G. (2022). Fungal Periprosthetic Hip Joint Infections. Diagnostics, 12.","DOI":"10.3390\/diagnostics12102341"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Koutserimpas, C., Chamakioti, I., Zervakis, S., Raptis, K., Alpantaki, K., Kofteridis, D.P., Vrioni, G., and Samonis, G. (2021). Non-Candida Fungal Prosthetic Joint Infections. Diagnostics, 11.","DOI":"10.3390\/diagnostics11081410"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Enz, A., Mueller, S.C., Warnke, P., Ellenrieder, M., Mittelmeier, W., and Klinder, A. (2021). Periprosthetic Fungal Infections in Severe Endoprosthetic Infections of the Hip and Knee Joint-A Retrospective Analysis of a Certified Arthroplasty Centre of Excellence. J. Fungi, 7.","DOI":"10.3390\/jof7060404"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Koutserimpas, C., Naoum, S., Alpantaki, K., Raptis, K., Dretakis, K., Vrioni, G., and Samonis, G. (2022). Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon\u2019s Nightmare. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071606"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/S1473-3099(18)30345-1","article-title":"Risk Factors Associated with Revision for Prosthetic Joint Infection after Hip Replacement: A Prospective Observational Cohort Study","volume":"18","author":"Lenguerrand","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S1473-3099(18)30755-2","article-title":"Risk Factors Associated with Revision for Prosthetic Joint Infection Following Knee Replacement: An Observational Cohort Study from England and Wales","volume":"19","author":"Lenguerrand","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"10","DOI":"10.4103\/0019-5413.106884","article-title":"Periprosthetic Joint Infection: Current Concept","volume":"47","author":"Aggarwal","year":"2013","journal-title":"Indian. J. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Fan, S., Wang, Z., Yan, X., and Luo, H. (2024). Systematic Review and Meta-Analysis of Single-Stage vs Two-Stage Revision for Periprosthetic Joint Infection: A Call for a Prospective Randomized Trial. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-07229-z"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Vrancianu, C.O., Serban, B., Gheorghe-Barbu, I., Czobor Barbu, I., Cristian, R.E., Chifiriuc, M.C., and Cirstoiu, C. (2023). The Challenge of Periprosthetic Joint Infection Diagnosis: From Current Methods to Emerging Biomarkers. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24054320"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s10096-022-04410-x","article-title":"Prosthetic Joint Infection Diagnosis Applying the Three-Level European Bone and Joint Infection Society (EBJIS) Approach","volume":"41","author":"Papalini","year":"2022","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s00264-019-04426-7","article-title":"Twenty Common Errors in the Diagnosis and Treatment of Periprosthetic Joint Infection","volume":"44","author":"Li","year":"2020","journal-title":"Int. Orthop."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"101245","DOI":"10.1016\/j.artd.2023.101245","article-title":"Novel Local Antifungal Treatment for Fungal Periprosthetic Joint Infection With Continuous Local Antibiotic Perfusion: A Surgical Technique","volume":"24","author":"Choe","year":"2023","journal-title":"Arthroplast. Today"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Tsikopoulos, K., and Meroni, G. (2023). Periprosthetic Joint Infection Diagnosis: A Narrative Review. Antibiotics, 12.","DOI":"10.3390\/antibiotics12101485"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Escol\u00e0-Verg\u00e9, L., Rodr\u00edguez-Pardo, D., Corona, P.S., and Pigrau, C. (2021). Candida Periprosthetic Joint Infection: Is It Curable?. Antibiotics, 10.","DOI":"10.3390\/antibiotics10040458"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"43","DOI":"10.21037\/aoj-20-85","article-title":"Biofilm Formation in Periprosthetic Joint Infections","volume":"6","author":"Staats","year":"2021","journal-title":"Ann. Jt."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Mikzi\u0144ski, P., Kraus, K., Widelski, J., and Paluch, E. (2024). Modern Microbiological Methods to Detect Biofilm Formation in Orthopedy and Suggestions for Antibiotic Therapy, with Particular Emphasis on Prosthetic Joint Infection (PJI). Microorganisms, 12.","DOI":"10.3390\/microorganisms12061198"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/206\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T15:23:31Z","timestamp":1759850611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/206"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,2]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14010206"],"URL":"https:\/\/doi.org\/10.3390\/jcm14010206","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,2]]}}}