EVALUATION OF CONTINUOUS LOCAL ANTIBIOTIC PERFUSION (CLAP) FOR THE TREATMENT OF FRACTURE-RELATED INFECTIONS

Aim Fracture-related infections (FRI) remain a challenging complication in orthopedic trauma care. Continuous local antibiotic perfusion (CLAP), which involves the direct infusion of a high concentrated gentamicin solution into infected bone via intra medullary antibiotic perfusion (iMAP) and/or via surrounding tissues via intra soft tissue antibiotic perfusion(iSAP), has recently emerged as a novel drug delivery system that offers potential advantages over traditional local antibiotic delivery. This study aimed to evaluate the efficacy of CLAP in patients with FRI. Method This retrospective cohort study was conducted at ten institutions and included 169 patients who underwent surgical treatment for FRI between 2019 and 2022 with a follow-up period of at least one year. The mean age of the patients was 53.1 years (range: 13-90 years). The primary outcome was the success rate of infection control, and the secondary outcomes included the recurrence rate and incidence of acute kidney injury (AKI). Patients were divided into two groups based on whether CLAP was performed: CLAP group and non-CLAP group. Univariate analysis was conducted to compare variables between the two groups. Multivariate analysis was performed with primary and secondary outcomes as dependent variables. Results The success rate was significantly higher in the CLAP group than that in the non-CLAP group (86% vs. 71%, p = 0.03). The recurrence rate was significantly higher in the non-CLAP group (13% vs. 32%, p = 0.003). There was no significant difference in the incidence of AKI between the two groups (p = 0.6). In multivariate analysis, CLAP was significantly associated with the success rate of infection control (OR 3.6, 95% CI: 1.37-9.42, p = 0.01). Furthermore, CLAP was associated with a lower rate of recurrence (OR 3.4, 95% CI: 1.47-7.77, p = 0.004). Regarding adverse effects, CLAP was not significantly associated with AKI (OR 1.76, 95% CI: 0.513-6.030, p = 0.37). Conclusions In this multi-center study of 169 FRI cases, CLAP was associated with a higher success rate of infection control and a lower recurrence rate without increasing adverse events.