Culture-proven osteoarticular mycoses: An eight-year single-center descriptive study of fungal distribution and antifungal susceptibility trends

OBJECTIVES: To describe the mycological profile of culture-proven osteoarticular mycoses (OAM) at a 5400-bed university hospital (2017-2024) according to clinical syndromes, and assess antifungal resistance trends. METHODS: Adults with deep osteoarticular specimens (bone, joint fluid, prosthetic material) positive by culture were retrospectively included. Isolations within ±15 days were grouped as a sample batch (SB). Patients were classified into four categories: ``Traumatic injury infection,'' ``Infection of prostheses and other materials,'' ``Craniofacial infection'' and ``Other infections''. Antifungal susceptibility testing (AST) was performed using gradient strips. RESULTS: Three hundred fifty-seven patients yielded 1993 analyzed specimens and 380 SB. Yeasts predominated outside ``Traumatic injury infection'' (range from 88.3 to 96.2%), mainly Candida albicans and Candida parapsilosis, whereas ``Traumatic injury infection'' was mold-dominant (64.0%), chiefly Aspergillus and Fusarium. AST was available for 306/357 (85.7%) Candida isolates; fluconazole resistance was found in 12/36 (33.3%) Candida glabrata, 5/67 (7.5%) C. parapsilosis, and 2/21 (9.5%) Candida tropicalis. No Aspergillus resistance was detected. Recurrence occurred in 18/357 (5.0%) patients; three developed azole resistance. CONCLUSIONS: OAM shows syndrome-specific fungal profiles, supporting syndrome-adapted diagnostic and therapeutic approaches. Although susceptibility profiles were largely stable, resistant and evolving phenotypes justify repeat culture and susceptibility testing during follow-up of these chronic infections.