Treatment experience with continuous local antibiotic perfusion for periprosthetic joint infection

• Published in: Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024-11, Vol.29 (6), p.1469-1476
• Main Authors: Miyake, Yoshiaki, Takagi, Toru
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Continuous local antibiotic perfusion; Debridement; Debridement, antibiotics, and implant retention; Female; Follow-Up Studies; Humans; Male; Middle Aged; Perfusion - methods; Periprosthetic joint infection; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Reoperation; Retrospective Studies; Treatment Outcome
• ISSN: 0949-2658; 1436-2023; 1436-2023
• DOI: 10.1016/j.jos.2023.12.001

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. 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. 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. All patients achieved infection resolution with the combined use of CLAP. This suggests that CLAP is a useful treatment option for PJI.