• Spine · Jun 2015

    Review

    Fungal Infections of the Spine.

    • Devin Ganesh, Jonathan Gottlieb, Sherilynn Chan, Octavio Martinez, and Frank Eismont.
    • From the *Orlando Health Orthopaedics Department, Orlando, FL †Department of Orthopaedics, University of Miami, Miami, FL ‡University of Miami, Coral Gables, FL.
    • Spine. 2015 Jun 15;40(12):E719-28.

    Study DesignReview of the literature.ObjectiveTo retrospectively examine the frequency of published fungal infections by species and the treatment algorithms used to eradicate the disease.Summary Of Background DataFungal infections of the spine present unique challenges to the modern multispecialty treatment team. Although rare in comparison with bacterial infections, fungal infections have been increasing in incidence over the past several decades. Evidences-based practice is limited to referencing smaller case series.MethodsMEDLINE, Scopus, and EMBASE searches were carried out by one of the authors as well as by the research desk at the University of Miami/Calder Memorial Library. We included peer-reviewed articles published between 1948 and September 2010; case reports, series, and reviews were all examined and compiled into a database.ResultsA total of 130 articles, representing 157 cases, were included in the review. Aspergillus (60 cases, 38.2% of the total) and Candida species (36 cases, 22.9% of the total) were the 2 most common organisms. Surgery was associated with a greater survival rate than medical management alone in patients with Aspergillus (26.9% mortality in surgical patients; 60% in medically treated patients) and Candida (0% vs. 28.6%). Overall mortality was 19.3%. The overall recurrence rate was 7.4%. Amphotericin use was associated with a higher mortality rate than azoles.ConclusionAspergillus is the most common published pathogen in fungal infections of the spine. Recent publications depicting the use of newer antifungal medications such as azoles report higher survival rates. Surgically treated patients in combination with antifungal therapy showed highest frequencies of patient survival in Aspergillus and Candida infections.Level Of Evidence3.

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