Continuous Local Antibiotic Perfusion for Refractory Musculoskeletal Infections: Functional and Patient-reported...

Continuous local antibiotic perfusion (CLAP), a novel treatment for bone and soft-tissue infections, maintains high local antimicrobial concentrations while minimizing systemic toxicity. Despite its effectiveness against biofilm-related infections and ability to preserve implants, the clinical indications, protocols, and patient-reported outcomes remain unclear. This study assessed the clinical outcomes and patient satisfaction following CLAP for musculoskeletal infections of varied etiologies and anatomical sites.

This retrospective series included consecutive patients undergoing CLAP at a single institution between January 2020 and March 2025. Eligible patients had fracture-related infections, osteomyelitis, soft-tissue abscesses, or post-operative wound infections diagnosed according to the 2018 Musculoskeletal Infection Society criteria. CLAP comprised gentamicin (1.2 mg/mL) delivered through infusion combined with negative-pressure wound therapy. Intravenous antibiotics were administered based on culture and sensitivity results. Primary outcomes included additional surgical procedures after CLAP initiation. Secondary outcomes included infection resolution, length of hospital stay, functional recovery, and patient satisfaction, assessed using a structured Likert-scale survey and the net promoter score (NPS). Most patients had undergone prior surgical debridement and systemic antibiotic therapy, and CLAP was introduced as an adjunct or salvage treatment in cases with persistent or difficult-to-control infection. Infection clearance was defined as the absence of clinical signs of infection, wound healing, and no requirement for further surgical intervention. Functional recovery was defined according to ambulation status in lower-extremity cases and ability to perform activities of daily living in upper-extremity cases.

Thirteen patients (median age, 75 years; 76.9% men) were included. Infections comprised fracture-related infection (n=8), osteomyelitis (n=2), and soft-tissue infection (n=3). Median CLAP duration was 21 days, and median hospital stay was 69 days. Infection clearance was achieved in 12 patients (92%) within a median of 37 days. Six patients (46.2%) required implant removal, and the median number of additional procedures was four. Functional recovery was good or partial in nine patients (69.3%). Satisfaction was high: 84.6% indicated that they would undergo the procedure again, and the mean NPS was 8.2, with no detractors. Implant removal was mainly performed because of persistent infection or compromised bone and soft-tissue conditions. In fracture-related infection cases, radiographic bone healing and clinical pain improvement were also observed during follow-up.

CLAP achieved high infection-clearance rates and favorable functional and satisfaction outcomes, supporting its feasibility as an adjunctive option within surgical and systemic antibiotic management for refractory musculoskeletal infections.