Clinical Outcomes and Adverse Events of Continuous Local Antibiotic Perfusion for Orthopedic Infections: A Multi-Category Retrospective Study.

INTRODUCTION

Bone and soft-tissue infections, including fracture-related infection (FRI), periprosthetic joint infection (PJI), and soft-tissue infection (STI), remain a significant challenge in orthopedic surgery. Continuous local antibiotic perfusion (CLAP) offers a promising local treatment strategy to maintain high antibiotic concentrations; however, robust real-world data obtained across different infection categories are limited.

MATERIALS AND

METHODS

This retrospective, multicenter study included 155 patients (FRI, n = 72; PJI, n = 22; STI, n = 61) treated with CLAP at tertiary emergency hospitals. PJI was defined by the Musculoskeletal Infection Society criteria, and FRI by international consensus criteria. The primary outcome was the absence of apparent recurrence and additional infection-related surgery during the available follow-up period. Secondary outcomes included serum gentamicin (GM) concentrations and adverse events, including renal impairment.

RESULTS

The proportions of patients meeting the primary outcome were 69.4% (50/72) in FRI, 77.3% (17/22) in PJI, and 78.7% (48/61) in STI. Renal impairment occurred in nine patients (5.8%), all of whom recovered after treatment adjustment. Maximum serum GM concentrations differed significantly among infection categories (p = 0.03). No systemic complications, such as pneumonia or pulmonary embolism, were directly attributable to CLAP therapy.

CONCLUSION

In this multicenter cohort, the proportions of patients without apparent recurrence or additional infection-related surgery during the available follow-up period were similar across FRI, PJI, and STI. Higher serum GM concentrations in PJI support careful serum gentamicin monitoring during CLAP therapy.