Efficacy of continuous local antibiotic perfusion for fracture-related infections

Aims: The aim of this multicentre retrospective study was to evaluate the efficacy of continuous local antibiotic perfusion in the management of patients with a fracture-related infection. Methods: The study included 170 patients with a fracture-related infection who were treated surgically at ten tertiary trauma centres between January 2019 and December 2022, with a minimum follow-up of one year. They were divided into continuous perfusion (n = 105) and non-continuous perfusion (n = 65) groups. The primary outcome was reoperation within one year. Secondary outcomes included recurrence of infection and acute renal failure. Univariate and multivariate logistic regression analyses were performed, followed by propensity score matching based on the classification of the elements of a fracture-related infection, to address baseline imbalances. Results: The rate of reoperation within one year was significantly lower in the continuous antibiotic perfusion group than in the non-continuous perfusion group (20.0% vs 43.1%; p = 0.002). The rate of recurrent infection was also significantly lower in the continuous perfusion group (12.4% vs 32.3%; p = 0.003). After multivariable adjustment, continuous perfusion remained independently associated with a reduced risk of reoperation (adjusted odds ratio (OR) 0.30 (95% CI 0.13 to 0.70)) and recurrence of infection (adjusted OR 0.28 (95% CI 0.11 to 0.73)). In the propensity score-matched cohort, continuous perfusion also remained significantly associated with a reduced risk of reoperation (18.6% vs 44.1%; p = 0.005) and recurrence of infection (8.5% vs 32.2%; p = 0.002). The incidence of acute renal failure did not differ significantly between the groups. Conclusion: Continuous local antibiotic perfusion was associated with a significantly lower rate of reoperation and recurrent infection in patients with a fracture-related infection, without an apparent increase in the rate of acute renal failure.