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Multicenter Study
. 2025 Sep 2;63(9):myaf080.
doi: 10.1093/mmy/myaf080.

Epidemiology and outcomes of Candida-associated osteoarticular infections: A multicentre retrospective study from Turkey

Özlem Güler  1 , Murat Üzel  2 , Dilşat Tepe  3 , Firdevs Aksoy  3 , Güle Çınar  4 , Kemal Osman Memikoğlu  4 , Bülent Durdu  5 , Tülay Ünver Ulusoy  6 , Aysun Benli̇  7 , Zeynep Karakaşoğlu  8 , Neşe Saltoğlu  8 , Derya Seyman  9 , Işıl Deniz Alıravcı  10 , Hasibullah Yaqoobi  11 , Ayça Aydın  12 , Hatun Öztürk Çerik  13 , Selin Özdemir  14 , Betül Sümer  15 , Azize Yetişgen  16 , Ayşe Batırel  17 , Ayşe Serra Özel  18 , Seniha Şenbayrak  19 , Yasemin Tezer Tekçe  20 , Zehra Çağla Karakoç  21
Affiliations
Multicenter Study

Epidemiology and outcomes of Candida-associated osteoarticular infections: A multicentre retrospective study from Turkey

Özlem Güler et al. Med Mycol. .

Abstract

This multicentre retrospective study investigated the epidemiology, clinical characteristics, and fluconazole resistance rates of Candida species in osteoarticular infections across Turkey as well as the factors influencing complete recovery. Data were gathered from 73 adult patients diagnosed with proven or probable Candida-associated osteoarticular infections between 2015 and 2025 from 20 healthcare centres. The most common clinical presentation was spondylodiscitis, followed by the involvement of phalangeal bones in the hands and feet. Non-albicansCandida species accounted for 37/73 cases (50.7%), with Candida parapsilosis being the most frequent. Fluconazole resistance was low among C. albicans isolates (3%) but higher among non-albicans yeasts (27%). Bacterial co-infection, predominantly Gram-positive bacteria, was detected in 52.1% of cases. Diabetes was present in 50/73 patients (68.5%), particularly insulin-dependent diabetes, and was a prominent comorbidity that may have also contributed as a predisposing factor. Radiological detection of osteomyelitis was achieved in 69.9% of patients. Fluconazole was the most commonly used antifungal agent (74%) with a median treatment duration of 90 days. Multivariate analysis revealed that surgical debridement was significantly associated with a higher odds of clinical recovery (adjusted odds ratio [aOR], 5.764; 95% confidence interval [CI], 1.360-24.434; P = .017), whereas diabetes mellitus was significantly associated with a lower odds of total recovery (aOR, 0.205; 95% CI, 0.053-0.792; P = .022). In conclusion, this multicentre study provides epidemiological data and fluconazole resistance rates of Candida species causing osteoarticular infections in Turkey, highlights the occurrence of C. auris in this cohort, and identifies surgical intervention and diabetes mellitus as factors significantly associated with recovery.

Keywords: Candida; arthritis; bone diseases; infectious; osteomyelitis; spondylodiscitis.

Plain language summary

This study analysed bone and joint infections with the yeast Candida from multiple Turkish hospitals over 10 years. Non-Candida albicans species were the most common (50.7%). The spine bones and discs were mostly affected. Diabetes was a key risk factor. Treatment generally lasted around 90 days.

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Conflict of interest statement

The authors declare that they have no conflicts of interest. This study was presented as an oral presentation at the 25th Turkish Clinical Microbiology and Infectious Diseases Congress (KLİMİK 2025), held in Antalya, Turkey, between April 24 and 27, 2025.

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