Work

Species distribution, antifungal susceptibility, and clinical profiles of patients with osteoarticular fungal Infections: A retrospective study

Year: 2025

Type: article

Abstract: Osteoarticular fungal infections (OAFIs), including fungal osteomyelitis and septic arthritis, represent uncommon but clinically significant complications in musculoskeletal care. Current management remains challenging due to limited evidence guiding antifungal selection. This study aims to characterize the epidemiological patterns, clinical features, and antifungal susceptibility profiles of OAFIs, with particular focus on the critical role of in vitro susceptibility testing in determining treatment outcomes. A retrospective study of patients was conducted with OAFIs treated between January 2020 and February 2024, analyzing clinical manifestations, surgical interventions, and associated risk factors. Fungal identification was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), followed by broth microdilution antifungal susceptibility testing for amphotericin B (AMB), fluconazole (FLC), voriconazole (VRC), and posaconazole (POS). Minimum inhibitory concentration (MIC) values were interpreted according to CLSI guidelines to determine susceptibility profiles and identify potential resistance mechanisms. Sixty fungal isolates were isolated from 60 patients with OAFIs including Candida spp. (n=40, 66.7%), Aspergillus spp. (n=14, 23.3%), Cryptococcus neoformans (n=2, 3.3%), Trichophyton rubrum (n=2, 3.3%), Lomentospora prolificans (n=1, 1.7%), and Cryptococcus laurentii (n=1, 1.7%). The isolates were obtained from joint fluid (n=48, 80%) and inflammatory lesions (n=12, 20%). Antifungal susceptibility testing demonstrated highest MIC values for FLC but susceptibility profiles for VRC and POS against all fungal isolates. Statistical analysis revealed significant differences in VRC and POS activity among Candida , Aspergillus , and Cryptococcus spp. (F = 15.78, P <0.01; F = 66.88, P <0.0001). VRC activity did not differ between Candida and Aspergillus spp., but both were lower than against Cryptococcus spp. ( P <0.05 and P <0.05). POS activity was higher against Candida than Aspergillus ( P <0.001) and Cryptococcus spp. ( P <0.0001), and higher against Cryptococcus than Aspergillus ( P <0.05). Systemic comorbidities were common (73.3%), one patient was HIV-positive, and three had only localized superficial fungal infections. We concluded that Candida albicans and Aspergillus fumigatus as the predominant pathogens in OAFIs, while rare species including Cryptococcus neoformans , Lomentospora prolificans , and Cryptococcus laurentii were also isolated from OAFI cases. Antifungal susceptibility testing revealed VRC and POS as potentially effective therapeutic options for OAFIs. These findings underscore the need for early detection of rare fungal pathogens, susceptibility-guided therapy, and continuous resistance surveillance in managing OAFIs in non-immunodeficient patients.

Source: New Microbes and New Infections

DOI: 10.1016/j.nmni.2025.101676

Authors: Jie Liu, Kaiming Zhang, Rui Yu, Haozhi Han, Peng Zhao

Institutions: Shanxi Medical University, Shanxi Provincial People’s Hospital, Shanxi University of Traditional Chinese Medicine

Language: English

Topic: Antifungal resistance and susceptibility

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,770