{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T23:41:48Z","timestamp":1780098108252,"version":"3.54.0"},"reference-count":40,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,8]],"date-time":"2021-03-08T00:00:00Z","timestamp":1615161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Biocomposites LTD","award":["12"],"award-info":[{"award-number":["12"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Antibiotic-tolerant bacterial biofilms are notorious in causing PJI. Antibiotic loaded calcium sulfate bead (CSB) bone void fillers and PMMA cement and powdered vancomycin (VP) have been used to achieve high local antibiotic concentrations; however, the effect of drainage on concentration is poorly understood. We designed an in vitro flow reactor which provides post-surgical drainage rates after knee revision surgery to determine antibiotic concentration profiles. Tobramycin and vancomycin concentrations were determined using LCMS, zones of inhibition confirmed potency and the area under the concentration\u2013time curve (AUC) at various time points was used to compare applications. Concentrations of antibiotcs from the PMMA and CSB initially increased then decreased before increasing after 2 to 3 h, correlating with decreased drainage, demonstrating that concentration was controlled by both release and flow rates. VP achieved the greatest AUC after 2 h, but rapidly dropped below inhibitory levels. CSB combined with PMMA achieved the greatest AUC after 2 h. The combination of PMMA and CSB may present an effective combination for killing biofilm bacteria; however, cytotoxicity and appropriate antibiotic stewardship should be considered. The model may be useful in comparing antibiotic concentration profiles when varying fluid exchange is important. However, further studies are required to assess its utility for predicting clinical efficacy.<\/jats:p>","DOI":"10.3390\/antibiotics10030270","type":"journal-article","created":{"date-parts":[[2021,3,8]],"date-time":"2021-03-08T12:12:18Z","timestamp":1615205538000},"page":"270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Elution Kinetics from Antibiotic-Loaded Calcium Sulfate Beads, Antibiotic-Loaded Polymethacrylate Spacers, and a Powdered Antibiotic Bolus for Surgical Site Infections in a Novel In Vitro Draining Knee Model"],"prefix":"10.3390","volume":"10","author":[{"given":"Kelly","family":"Moore","sequence":"first","affiliation":[{"name":"Wexner Medical Center, Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4614-1047","authenticated-orcid":false,"given":"Rebecca Wilson-van","family":"Os","sequence":"additional","affiliation":[{"name":"Biocomposites Ltd., Keele Science Park, Keele, Staffordshire ST5 5NL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4340-6214","authenticated-orcid":false,"given":"Devendra H.","family":"Dusane","sequence":"additional","affiliation":[{"name":"Wexner Medical Center, Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Center for Clinical and Translational Research, The Research Institute at Nationwide Children\u2019s Hospital, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6903-4389","authenticated-orcid":false,"given":"Jacob R.","family":"Brooks","sequence":"additional","affiliation":[{"name":"Wexner Medical Center, Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5768-2669","authenticated-orcid":false,"given":"Craig","family":"Delury","sequence":"additional","affiliation":[{"name":"Biocomposites Ltd., Keele Science Park, Keele, Staffordshire ST5 5NL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean S.","family":"Aiken","sequence":"additional","affiliation":[{"name":"Biocomposites Ltd., Keele Science Park, Keele, Staffordshire ST5 5NL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8832-8497","authenticated-orcid":false,"given":"Phillip A.","family":"Laycock","sequence":"additional","affiliation":[{"name":"Biocomposites Ltd., Keele Science Park, Keele, Staffordshire ST5 5NL, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne C.","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Wexner Medical Center, Department of Orthopaedics, The Ohio State University, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey F.","family":"Granger","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Research, The Research Institute at Nationwide Children\u2019s Hospital, Columbus, OH 43210, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5978-8662","authenticated-orcid":false,"given":"Matthew V.","family":"Dipane","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA 90403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"McPherson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA 90403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6069-273X","authenticated-orcid":false,"given":"Paul","family":"Stoodley","sequence":"additional","affiliation":[{"name":"Wexner Medical Center, Department of Microbial Infection and Immunity, The Ohio State University, Columbus, OH 43210, USA"},{"name":"Wexner Medical Center, Department of Orthopaedics, The Ohio State University, Columbus, OH 43210, USA"},{"name":"National Centre for Advanced Tribology at Southampton (nCATS), National Biofilm Innovation Centre (NBIC), Department of Mechanical Engineering, University of Southampton, Southampton SO17 1BJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.arth.2012.02.022","article-title":"Economic burden of periprosthetic joint infection in the united states","volume":"27","author":"Kurtz","year":"2012","journal-title":"J. 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