Two hundred and eleven cases of Candida osteomyelitis: 17 case reports and a review of the literature

Candida osteomyelitis is a rare infection. We present 17 cases of Candida osteomyelitis from our institution and review 194 patients from the literature. The median age of patients was 57 ± 22 years (range, 18–90 years) with 68% male. Comorbidities associated with this infection include prior surgery (62%), broad-spectrum antibiotics (40%), central venous catheter insertion (19%), and immunosuppression (17%). The most common infecting species were Candida albicans (69%), Candida tropicalis (15%), and Candida glabrata (8%). Most initial antifungal regimens included amphotericin B (59%); however, fluconazole is increasingly being utilized for treatment of this infection (26%). Echinocandins were used infrequently (4%). Median length of treatment was 3 ± 4.5 months (mean, 4.2 months; range, 18 days to 36 months). The overall success rate of therapy was 91%, with 75% of patients cured by 6 months. The crude mortality rate was 12% with an attributable mortality rate of 6%.