{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T02:49:22Z","timestamp":1788922162073,"version":"build-2803163510"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EIC accelerator","award":["190184905"],"award-info":[{"award-number":["190184905"]}]},{"name":"DARTBAC","award":["NWA.1292.19.354"],"award-info":[{"award-number":["NWA.1292.19.354"]}]},{"name":"EMILIO","award":["LSHM21057"],"award-info":[{"award-number":["LSHM21057"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Peri-prosthetic joint infection (PJI) is a severe complication that can arise following joint replacement surgery. PJI treatment is extremely complex due to the formation of bacterial biofilms and the emergence of antimicrobial resistance (AMR) to antibiotic classes commonly used in the treatment of PJI. This critical development highlights the urgent need for novel prophylactic strategies that do not rely on conventional antibiotic agents to prevent bacterial adherence and subsequent biofilm formation on implant surfaces. This study evaluated the contact-killing properties of a supramolecular poly-epsilon-lysine and hyaluronic acid (PEL-10\/HA-1) coating on an intramedullary nail in a New Zealand White (NZW) rabbit model. Fifteen female NZW rabbits were inoculated with\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    (JAR 060131, 5.9 x 10\n                    <jats:sup>4<\/jats:sup>\n                    CFU in 100 \u00b5L PBS) in the right humerus. Seven received an uncoated nail, while eight received a PEL-10\/HA-1 coated titanium alloy nail. After 7 days, the rabbits were euthanized for microbiological analysis of the nail and surrounding tissues. Remarkably, microbiological analysis showed that 4\/8 of the rabbits with a coated nail had 0 CFU on the nail, versus 1\/8 of the rabbits with an uncoated nail. The rinsing solution, soft tissue, and bone samples from the rabbits with a coated nail were more often culture-negative than the samples from rabbits with an uncoated nail. However, no statistically significant differences were observed between the CFUs of the coated and uncoated groups. There were no statistically significant differences between the coated and uncoated groups in other infection indicators, including white blood cell count, C-reactive protein, and plasma protein electrophoresis. While the PEL-10\/HA-1 coating had a bacteriostatic and bactericidal effect\n                    <jats:italic>in vitro<\/jats:italic>\n                    , this effect did not translate to\n                    <jats:italic>in vivo<\/jats:italic>\n                    , highlighting a translational gap. The PEL-10\/HA-1 coating must be optimized to enhance its antimicrobial effect, ensuring the same promising in vivo effect as previously observed\n                    <jats:italic>in vitro.<\/jats:italic>\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0343597","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T18:25:51Z","timestamp":1772648751000},"page":"e0343597","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["In vivo evaluation of the antibacterial properties of a poly-\u03b5-lysine and hyaluronic acid coated intramedullary implant in a New Zealand White rabbit model"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3377-7399","authenticated-orcid":true,"given":"Julia L.","family":"van Agtmaal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne W. G.","family":"van Hoogstraten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9mie","family":"Reinert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1730-3695","authenticated-orcid":true,"given":"Cynthia","family":"Calligaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajendra","family":"Kasinath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Zindl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8155-4202","authenticated-orcid":true,"given":"Stephan","family":"Zeiter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihal Engin","family":"Vrana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim J. M.","family":"Welting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacobus J. C.","family":"Arts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,4]]},"reference":[{"issue":"12","key":"pone.0343597.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2023.06.015","article-title":"The Effect of Prosthetic Joint Infection on Work Status and Quality of Life: A Multicenter, International Study","volume":"38","author":"I Shichman","year":"2023","journal-title":"J Arthroplasty"},{"issue":"1","key":"pone.0343597.ref002","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1186\/s12891-022-06024-y","article-title":"Increased short- and long-term mortality amongst patients with early periprosthetic knee joint infection","volume":"23","author":"O Thompson","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"issue":"3","key":"pone.0343597.ref003","doi-asserted-by":"crossref","first-page":"138","DOI":"10.5371\/hp.2018.30.3.138","article-title":"Management of Periprosthetic Joint Infection","volume":"30","author":"C Li","year":"2018","journal-title":"Hip Pelvis"},{"issue":"5","key":"pone.0343597.ref004","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2020.12.005","article-title":"Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States","volume":"36","author":"A Premkumar","year":"2021","journal-title":"J Arthroplasty"},{"key":"pone.0343597.ref005","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1302\/2058-5241.4.180095","article-title":"Implant materials and prosthetic joint infection: The battle with the biofilm","author":"DJ Davidson","year":"2019","journal-title":"EFORT Open Rev"},{"issue":"11","key":"pone.0343597.ref006","doi-asserted-by":"crossref","DOI":"10.1111\/1469-0691.12649","article-title":"Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. 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