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Published on: October 16, 2014
Continuous Local Antibiotic Perfusion: A Novel Technique for the Treatment of Orthopaedic Infections: Narrative
Hyonmin Choe1, Akihiro Maruo2, Daisuke Himeno3
1Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan.
Background:
Orthopedic infections, including fracture-related infection and periprosthetic joint infection (PJI), remain difficult to eradicate because bacteria within biofilms exhibit high tolerance to systemic antibiotics. Conventional antibacterial strategies based on minimum inhibitory concentration often fail in the biofilm environment, where substantially higher antimicrobial concentrations are required. Continuous local antibiotic perfusion (CLAP) has emerged as a technique that enables sustained delivery of high local antibiotic concentrations directly to the infected site while providing continuous drainage using negative pressure wound therapy.
Methods:
This narrative review summarizes the principles, technical aspects, clinical indications, and reported outcomes of CLAP. A literature search of the MEDLINE database was conducted up to July 2025 using the term "continuous local antibiotic perfusion." Clinical studies describing the use of CLAP in orthopedic infections, including case reports, case series, and retrospective studies, were reviewed. Perfusion strategies (iMAP, iSAP, iJAP, and TRAP), antibiotic regimens, safety considerations, and current limitations were analyzed.
Results:
CLAP enabled delivery of high local antibiotic concentrations exceeding the minimum biofilm eradication concentration while maintaining relatively low systemic exposure. Favorable outcomes for infection control, implant retention, and fracture union, were reported across various intractable infections, including fungal PJI. Complications such as transient elevations in serum antibiotic levels and renal dysfunction were reported but appeared to be infrequent. Although CLAP has shown potential utility in refractory infections, further high-quality studies with rigorous safety evaluations are required to strengthen the evidence base.
Conclusion:
CLAP is a promising adjunctive strategy for challenging orthopedic infections, offering targeted high-concentration antibiotic delivery with effective drainage. However, current evidence is limited to low-level studies. Prospective trials, standardized protocols, and long-term safety evaluations are needed to define its role in clinical practice.
Insights
Continuous local antibiotic perfusion (CLAP) offers a promising method for treating challenging orthopedic infections by delivering high antibiotic concentrations directly to the infection site. This technique shows potential for improved infection control and implant retention, though further research is needed.
Area of Science:
- Orthopedic surgery
- Infectious diseases
- Biomaterials
Background:
- Orthopedic infections, such as fracture-related infections and periprosthetic joint infections (PJI), are difficult to treat due to bacterial biofilm resistance to systemic antibiotics.
- Conventional antibiotic strategies often fail in biofilm environments, requiring higher antimicrobial concentrations.
- Continuous local antibiotic perfusion (CLAP) provides sustained, high local antibiotic delivery and drainage.
Purpose of the Study:
- To review the principles, technical aspects, clinical indications, and outcomes of CLAP for orthopedic infections.
- To analyze different perfusion strategies, antibiotic regimens, and safety considerations.
- To assess the current evidence base and limitations of CLAP.
Main Methods:
- A narrative review of the MEDLINE database up to July 2025 was conducted.
- The search term used was "continuous local antibiotic perfusion."
- Clinical studies including case reports, case series, and retrospective studies were reviewed.
Main Results:
- CLAP achieved high local antibiotic concentrations, exceeding minimum biofilm eradication concentrations, with low systemic exposure.
- Favorable outcomes in infection control, implant retention, and fracture union were reported for various refractory infections, including fungal PJI.
- Complications like transient serum antibiotic level elevations and renal dysfunction were infrequent.
Conclusions:
- CLAP is a promising adjunctive strategy for challenging orthopedic infections, enabling targeted high-concentration antibiotic delivery and drainage.
- Current evidence is primarily from low-level studies.
- Further high-quality prospective trials and long-term safety evaluations are necessary to establish CLAP's clinical role.
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