Treatment of orthopaedic infections using continuous local antibiotic perfusion

Background: Management of orthopedic implant-related infections is complicated by bacterial biofilms, which provide a protective environment against host immune responses and systemic antimicrobial agents. Standard systemic therapy often fails to reach the minimum biofilm eradication concentration (MBEC), necessitating local delivery strategies to address periprosthetic joint infections, fracture-related infections, and osteomyelitis.

Objective: This article evaluates the methodology, clinical applications, and current evidence regarding continuous local antibiotic perfusion (CLAP) as a technique for delivering high-concentration antimicrobials to infected orthopedic sites.

Key Points: CLAP utilizes low-flow antibiotic infusion into intramedullary (iMAP), soft tissue (iSAP), or intra-articular (iJAP) compartments combined with negative pressure wound therapy (NPWT). This dual-action system facilitates continuous drainage of exudates while maintaining high local drug concentrations targeting the MBEC. Clinical data indicate high rates of implant retention and bone union in fracture-related infections and successful outcomes in spinal surgical site infections and fungal periprosthetic joint infections. Despite these results, challenges remain regarding the standardization of infusion protocols, potential bone toxicity from high-concentration aminoglycosides, and the risk of renal impairment. Current evidence is primarily limited to retrospective cohorts and case series.

Conclusion: CLAP represents a specialized local delivery strategy that may allow for implant preservation in refractory orthopedic infections. While initial clinical outcomes are favorable, prospective trials are required to establish standardized dosing, safety benchmarks, and definitive indications for its application in musculoskeletal infection management.