Continuous Local Antibiotic Perfusion: A Novel Technique for the Treatment of Orthopaedic Infections

Dr Supreeth  D R

Continuous Local Antibiotic Perfusion: A Novel Technique for the Treatment of Orthopaedic Infections

Written By : Dr Supreeth D R Published On 2026-02-04T20:00:59+05:30 | Updated On 4 Feb 2026 8:01 PM IST

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.

The narrative review by Hyonmin Choe et al summarizes the principles, technical aspects, clinical indications, and reported outcomes of CLAP. A literature search of the MEDLINE database was conducted 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.

The key findings were:

• 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.

The authors concluded – “CLAP is an emerging therapeutic strategy for orthopaedic infections that enables the delivery of high local concentrations of antibiotics while simultaneously providing continuous drainage. Its clinical utility has been reported in a range of musculoskeletal infections; however, the supporting evidence is predominantly limited to case reports and retrospective analyses. Future priorities include the conduct of prospective randomized controlled trials, the development of standardized treatment protocols, and systematic evaluation of long-term safety.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.