Management of Fungal Osteoarticular Infections

Purpose of ReviewThis review summarizes our current understanding of the medical and surgical management of fungal osteoarticular infections (FOAI). These infections are uncommon, heterogenous, and often severe; management is often highly dependent on expert opinion with a dearth of high-quality evidence.Recent FindingsFOAI can be broadly categorized into three groups: native infections with endemic fungi, hematogenous infections among patients with underlying immunodeficiency, and complications of orthopedic surgery. Management of this diverse set of infections relies on careful coordination with orthopedic surgery, and attention to the patient's overall medical and orthopedic prognosis. Extended courses of antifungal therapy are generally used, although shorter courses may be reasonable when surgical extirpation of infection is complete, and finite antifungal therapy is usually unsuccessful when infected hardware is not resected.Future advances in management of FOAI may emerge as more is learned about eradicating biofilm-embedded persister cells, as the roles of depot and topical antifungal agents are further elucidated, and as effective therapeutic drug monitoring is developed for these uncommon, but devastating, conditions.