Experience with amphotericin B deoxycholate loaded bone cement in staged treatment of osteoarticular infections

The osteoarticular infections arena can include osteomyelitis, septic arthritis, fracture-related infections and periprostheticjoint infections, the latestone of the most feared postsurgical complication after joint replacement surgery. Fungal infections are much less frequent than bacterial infections; however, they have, theoretically, a poorer prognosis. The most accepted treatment for any musculoskeletal fungal infection is a stagedsurgical approach, which implies, apart from surgical debridement the administration of antibiotics and antifungals, bothsystemically and locally thought drug-loaded bone cement used to conform and/or fix bone-cement spacers, bone substitutes or auto/allografts. Two cases are presented in this paper. The first patient sustaineda chronic osteomyelitis and the second a delayedhip periprostheticjoint infection; the pathogens were a Candida parapsilopsis and Candida albicans respectively. Both patients underwent a surgical procedure using high doses of local amphotericin B deoxycholate powder (Amphotericin B for injection USP®), together with vancomycin and gentamicin during the first step of the procedure- once the infection was considered controlled a secondary reconstructive procedure was performed. Both patients had an adequate clinical evolution, with neither renal impairment nor other antifungal-related adverse events. To this day, patients have not suffered relapse of the fungal infection