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Treatment experience with continuous local antibiotic perfusion for periprosthetic joint infection
Yoshiaki Miyake1, Toru Takagi1
1Department of Orthopaedic Surgery, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-ku, Okayama, 700-8607, Japan.
Background:
Antibiotic concentrations 100-1000 times higher than the minimum inhibitory concentration are necessary for eradicating biofilms in periprosthetic joint infections (PJI). Achieving this with intravenous antibiotics is challenging, but continuous local antibiotic perfusion (CLAP) can increase the local concentration of antibiotics. Although there are several reports on CLAP therapy in the fracture-related infection, there are only few reports on its application in PJI. Here, we report our experience with CLAP therapy for PJI.
Methods:
Eight patients with PJI (two males and six females, with mean age of 73.5 years [±11.6]) were treated at our department, and their clinical characteristics were analyzed. The parameters considered were the classification of PJI, surgical procedure, duration of CLAP, duration of transvenous antibiotic administration, time of CRP-negative status, whether the infection resolved or recurred, and whether there were complications due to CLAP.
Results:
Initial surgery included total knee arthroplasty in five cases, unicompartmental knee arthroplasty in one case, and total hip arthroplasty in two cases. There were four cases of early postoperative infection, two of acute delayed infection, and two of chronic delayed infection. The surgical procedures performed were two-stage revision for two patients, and debridement, antibiotics, and implant retention (DAIR) for the other six. The mean durations of CLAP and transvenous antibiotic administration were 8.5 (±2.4) and 22.4 days (±13.7), respectively, and the mean time to CRP-negative status was 23.3 days (±10.7). All eight patients successfully resolved without additional irrigation or debridement, and no recurrence was observed at the last follow-up after discontinuation of oral antibiotics. No systemic side effects of gentamicin or other complications associated with CLAP were observed.
Conclusion:
All patients achieved infection resolution with the combined use of CLAP. This suggests that CLAP is a useful treatment option for PJI.
Insights
Continuous local antibiotic perfusion (CLAP) effectively treats periprosthetic joint infections (PJI). This method achieved successful infection resolution in all treated patients without recurrence or complications.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Periprosthetic joint infections (PJI) require high antibiotic concentrations for biofilm eradication.
- Achieving therapeutic antibiotic levels via intravenous administration in PJI is challenging.
- Continuous local antibiotic perfusion (CLAP) offers a method to increase local antibiotic concentrations.
Purpose of the Study:
- To evaluate the efficacy and safety of CLAP in treating PJI.
- To report clinical outcomes of patients with PJI treated with CLAP.
Main Methods:
- Retrospective analysis of eight patients with PJI treated with CLAP.
- Parameters analyzed included PJI classification, surgical procedure, CLAP duration, and infection resolution.
- Transvenous antibiotic administration and C-reactive protein (CRP) levels were monitored.
Main Results:
- All eight patients (mean age 73.5 years) achieved successful infection resolution.
- Mean CLAP duration was 8.5 days, and mean transvenous antibiotic administration was 22.4 days.
- No recurrence or systemic side effects of CLAP were observed.
Conclusions:
- CLAP is a valuable treatment option for PJI.
- The combined use of CLAP led to successful infection resolution in all patients.
- CLAP demonstrated a favorable safety profile in this PJI cohort.
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