Epidemiology and Outcomes of <i>Candida</i>-Associated Osteoarticular Infections: A Multicenter Retrospective Study from Turkey

This multicentre retrospective study investigated the epidemiology, clinical characteristics, and fluconazole resistance rates of Candida species in osteoarticular infections across Turkey as well as the factors influencing complete recovery. Data were gathered from 73 adult patients diagnosed with proven or probable Candida-associated osteoarticular infections between 2015 and 2025 from 20 healthcare centres. The most common clinical presentation was spondylodiscitis, followed by the involvement of phalangeal bones in the hands and feet. Non-albicansCandida species accounted for 37/73 cases (50.7%), with Candida parapsilosis being the most frequent. Fluconazole resistance was low among C. albicans isolates (3%) but higher among non-albicans yeasts (27%). Bacterial co-infection, predominantly Gram-positive bacteria, was detected in 52.1% of cases. Diabetes was present in 50/73 patients (68.5%), particularly insulin-dependent diabetes, and was a prominent comorbidity that may have also contributed as a predisposing factor. Radiological detection of osteomyelitis was achieved in 69.9% of patients. Fluconazole was the most commonly used antifungal agent (74%) with a median treatment duration of 90 days. Multivariate analysis revealed that surgical debridement was significantly associated with a higher odds of clinical recovery (adjusted odds ratio [aOR], 5.764; 95% confidence interval [CI], 1.360-24.434; P = .017), whereas diabetes mellitus was significantly associated with a lower odds of total recovery (aOR, 0.205; 95% CI, 0.053-0.792; P = .022). In conclusion, this multicentre study provides epidemiological data and fluconazole resistance rates of Candida species causing osteoarticular infections in Turkey, highlights the occurrence of C. auris in this cohort, and identifies surgical intervention and diabetes mellitus as factors significantly associated with recovery.

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Journal
Medical Mycology
Published
2025-09-01
DOI
https://doi.org/10.1093/mmy/myaf080
Primary Topic
Antifungal resistance and susceptibility
Type
article
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article

Epidemiology and Outcomes of Candida-Associated Osteoarticular Infections: A Multicenter Retrospective Study from Turkey

Kemal Osman Memikoğlu, Işıl Deniz Aliravci, Bülent Durdu, Betül Sümer et al.
Medical Mycology
Antifungal resistance and susceptibility
article

Epidemiology and Outcomes of Candida-Associated Osteoarticular Infections: A Multicenter Retrospective Study from Turkey

Kemal Osman Memikoğlu, Işıl Deniz Aliravci, Bülent Durdu, Betül Sümer, Murat Üzel, Yasemin Tezer Tekçe, Seniha Şenbayrak, Tülay Ünver Ulusoy, Azize Yetişgen, Ayşe Serra Özel, Neşe Saltoğlu, Dilşat Tepe, Hasibullah Yaqoobi, Ayşe Batırel, Firdevs Aksoy, Güle Çınar, Ayça Aydin, Derya Seyman, Aysun Benli, Zehra Çağla Karakoç, Hatun Öztürk Çerik, Selin Özdemir, Özlem Güler, Zeynep Karakaşoğlu
article en

Abstract

This multicentre retrospective study investigated the epidemiology, clinical characteristics, and fluconazole resistance rates of Candida species in osteoarticular infections across Turkey as well as the factors influencing complete recovery. Data were gathered from 73 adult patients diagnosed with proven or probable Candida-associated osteoarticular infections between 2015 and 2025 from 20 healthcare centres. The most common clinical presentation was spondylodiscitis, followed by the involvement of phalangeal bones in the hands and feet. Non-albicansCandida species accounted for 37/73 cases (50.7%), with Candida parapsilosis being the most frequent. Fluconazole resistance was low among C. albicans isolates (3%) but higher among non-albicans yeasts (27%). Bacterial co-infection, predominantly Gram-positive bacteria, was detected in 52.1% of cases. Diabetes was present in 50/73 patients (68.5%), particularly insulin-dependent diabetes, and was a prominent comorbidity that may have also contributed as a predisposing factor. Radiological detection of osteomyelitis was achieved in 69.9% of patients. Fluconazole was the most commonly used antifungal agent (74%) with a median treatment duration of 90 days. Multivariate analysis revealed that surgical debridement was significantly associated with a higher odds of clinical recovery (adjusted odds ratio [aOR], 5.764; 95% confidence interval [CI], 1.360-24.434; P = .017), whereas diabetes mellitus was significantly associated with a lower odds of total recovery (aOR, 0.205; 95% CI, 0.053-0.792; P = .022). In conclusion, this multicentre study provides epidemiological data and fluconazole resistance rates of Candida species causing osteoarticular infections in Turkey, highlights the occurrence of C. auris in this cohort, and identifies surgical intervention and diabetes mellitus as factors significantly associated with recovery.

Medical MycologyVol. 63(9)
Çanakkale Onsekiz Mart Üniversitesi (TR), Izmir University (TR), Ankara University (TR), Karadeniz Technical University (TR), Erzincan Binali Yıldırım University (TR), Başkent University (TR), Bezmiâlem Vakıf Üniversitesi (TR), Chest Diseases Hospital (KW), Memorial Ankara Hospital (TR), Dr Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi (TR), Antalya Eğitim ve Araştırma Hastanesi (TR), Ümraniye Eğitim ve Araştırma Hastanesi (TR), Malatya Turgut Özal Üniversitesi (TR), Istanbul University-Cerrahpaşa (TR), Haydarpaşa Numune Eğitim ve Araştırma Hastanesi (TR), Sağlık Bilimleri Üniversitesi (TR), Malatya Devlet Hastanesi (TR), Fatih Sultan Mehmet Eğitim Ve Araştırma Hastanesi (TR), Kocaeli Üniversitesi (TR), Ordu University (TR), Istanbul University (TR), University of Health Sciences Antigua (AG)
Openalex Percentile: Top 72%
Antifungal resistance and susceptibility
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