{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T03:19:00Z","timestamp":1793848740528,"version":"4.6.1"},"reference-count":70,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"PRO-IMPLANT Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>(1) Background: The addition of antibiotics to bone cements is a common practice in the treatment of periprosthetic joint infections. In revision cases, the amount and type of antibiotic is often insufficient and additional antibiotics must be added. The addition, however, changes the product itself, and the surgeon becomes the \u201cmanufacturer\u201d of the bone cement. PMMAe wished to clarify whether the admixture of antibiotics changes the mechanical stability of the bone cements used and if the added antibiotics were still functional and released in sufficient quantities. (2) Methods: We compared two industrially manufactured vancomycin-containing PMMA cements; the low-viscous VancogenX\u00ae (TECRES, Sommacampagna, Italy) and the high-viscous Copal\u00ae G+V (Heraeus Medical GmbH, Wehrheim, Germany), with two PMMA cements loaded with aminoglycosides, to which 2.0 g of vancomycin (Hexal CT1631) were manually added\u2014the high-viscous Smartset\u00ae GHV and the medium-viscous Antibiotic Simplex with Tobramycin (antibiotic Simplex\u00ae T). Test specimens of the bone cements were used to determine mechanical stability (bending strength and bending module), and the release of the antibiotics was determined by HLPC and modified Kirby\u2013Bauer assays. (3) Results: All tested bone cements showed an initial high release within the first hours. Repeated testing after 24 h showed a reduced efficacy of VancogenX\u00ae and Smartset\u00ae GHV in Kirby\u2013Bauer assays. Long-time release over days showed a release of functional antimicrobial active ingredients over this period of time in anti-microbial assays, but no activity of VancogenX\u00ae from day 21 onward. No significant differences in the ISO bending modules could be detected, but in contrast to the bending module, the ISO bending strength was substantially reduced by 10\u201315 mPal in comparison to both cements of the reference group. The Simplex\u00aeT met just the ISO 5833; the Smartset\u00ae GHV did not after adding vancomycin. (4) Conclusions: In conclusion, the manual addition of 2 g of vancomycin to 40 g of PMMA powder is recommended for the treatment of methicillin-resistant staphylococci. Vancomycin is released over a period of 42 days with concentrations above the MIC for typical staphylococci. The mechanical properties of the PMMA just met, or did not fulfill, ISO mechanical specification. Copal\u00ae G+V showed a better elution than VancogenX\u00ae over time.<\/jats:p>","DOI":"10.3390\/antibiotics13080721","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T11:34:20Z","timestamp":1722512060000},"page":"721","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of Manual Addition of Vancomycin to Polymethylmethacrylate (PMMA) Cements"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8472-2155","authenticated-orcid":false,"given":"Clemens","family":"Kittinger","sequence":"first","affiliation":[{"name":"Development and Research Insitute of Hygiene, Microbiology and Environmental Medicine, Hygiene Medical University of Graz, Neue Stiftingtalstra\u00dfe 6\/III 1, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9295-0972","authenticated-orcid":false,"given":"Michael","family":"Eder-Halbedl","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma, LKH-Feldbach, Ottokar-Kernstock-Stra\u00dfe 18, 8330 Feldbach, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-4943","authenticated-orcid":false,"given":"Klaus Dieter","family":"K\u00fchn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Trauma, Medical University of Graz, 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"K\u00fchn, K.D. (2014). PMMA Cements Are We Aware What We Are Using?, Springer.","DOI":"10.1007\/978-3-642-41536-4"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Chaiyakit, P., Meknavin, S., Honku, N., and Onklin, I. (2021). Debridement, antibiotics, and implant retention combined with direct intra-articular antibiotic infusion in patients with acute hematogenous periprosthetic joint infection of the knee. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-021-04451-x"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101245","DOI":"10.1016\/j.artd.2023.101245","article-title":"Novel local antibiotic antifungal treatment for fungal periprosthetic joint infection with continous local antibiotic perfusion: A surgical technique","volume":"24","author":"Choe","year":"2023","journal-title":"Arthroplast. Today"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Miyake, Y., and Takagi, T. (2023). Treatment experience with continous local antibiotic perfusion for periprosthetic joint infection. J. Orthop. Sci., Online ahead of print.","DOI":"10.1016\/j.jos.2023.12.001"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4741","DOI":"10.1007\/s00402-023-04770-9","article-title":"Clinical impact of microbiology results in two-stage revision arthroplasty with spacer exchange","volume":"143","author":"Frank","year":"2023","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_6","first-page":"243","article-title":"Prosthetic joint infections: Update in diagnosis and treatment","volume":"17\u201318","author":"Trampuz","year":"2005","journal-title":"Swiss. Med. Wkly."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1056\/NEJMra040181","article-title":"Prosthetic-joint infections","volume":"16","author":"Zimmerli","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1844","DOI":"10.1016\/j.arth.2018.01.056","article-title":"Changes in antibiotic susceptibility of staphylococcus aureus between the stages of 2-stage revision arthroplasty","volume":"33","author":"George","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Renz, N., Trebse, R., Akg\u00fcn, D., Perka, C., and Trampuz, A. (2019). Enterococcal periprosthetic joint infection: Clinical and microbiological findings from 8-year retrospective cohort study. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4691-y"},{"key":"ref_10","unstructured":"Walenkamp, G. (2007). Antibiotic choices in bone surgery-local therapy using antibiotic-loaded bone cement. Local Antibiotics in Arthroplasty, Georg Thieme Verlag."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"441","DOI":"10.2106\/JBJS.N.00023","article-title":"International consensus on periprosthetic joint infection: Let cumulative wisdom be a guide","volume":"6","author":"Parvizi","year":"2014","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/j.arth.2015.02.040","article-title":"Evaluation of elution and mechanical properties of high-dose antibiotic-loaded bone cement: Comparative \u201cin vitro\u201d study of the influence of vancomycin and cefazolin","volume":"8","author":"Paz","year":"2015","journal-title":"J. Arthroplast."},{"key":"ref_13","unstructured":"K\u00fchn, K.D. (2018). PMMA cements in revision surgery. Management of Periprosthetic Joint Infection. A Global Perspective on Diagnosis, Treatment Options, Prevention Strategies and Their Economic Impact, Springer."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s00402-018-3052-4","article-title":"Outcome of short versus long interval in two-stage exchange of periprosthetic joint infection: A prospective cohort study","volume":"139","author":"Winkler","year":"2019","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s42836-023-00185-4","article-title":"Interval between two-stage exchanges: What is optimal and how do we know?","volume":"5","author":"Sousa","year":"2023","journal-title":"Arthroplasty"},{"key":"ref_16","first-page":"166","article-title":"In vitro comparison between commercially and manually mixed antibiotic-loaded bone cements","volume":"3","author":"Ferraris","year":"2010","journal-title":"J. Appl. Biomater. Biomech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1016\/j.msec.2013.03.032","article-title":"Antibiotic-loaded acrylic bone cements: An in vitro study on the release mechanism and its efficacy","volume":"5","author":"Miola","year":"2013","journal-title":"Mater. Sci. Eng. C Mater. Biol. Appl."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1080\/00016470310018180","article-title":"The effect of mixing on gentamicin release from polymethylmethacrylate bone cements","volume":"6","author":"Neut","year":"2003","journal-title":"Acta Orthop. Scand."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1243\/09544119JEIM355","article-title":"Incorporation of large amounts of gentamicin sulphate into acrylic bone cement: Effect on handling and mechanical properties, antibiotic release, and biofilm formation","volume":"3","author":"Dunne","year":"2008","journal-title":"Proc. Inst. Mech. Eng. Part H J. Eng. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1002\/jbm.10405","article-title":"Effect of antibiotics on the properties of poly(methylmethacrylate)-based bone cement","volume":"6","author":"He","year":"2002","journal-title":"J. Biomed. Mater. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1002\/jbm.820100610","article-title":"Mechanical properties of bone cements containing large doses of antibiotic powders","volume":"6","author":"Lautenschlager","year":"1976","journal-title":"J. Biomed. Mater. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1002\/jbm.820100603","article-title":"Mechanical strength of acrylic bone cements impregnated with antibiotics","volume":"6","author":"Lautenschlager","year":"1976","journal-title":"J. Biomed. Mater. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1007\/s00264-008-0521-3","article-title":"The effect of vancomycin addition to the compression strength of antibiotic-loaded bone cements","volume":"3","author":"Lilikakis","year":"2009","journal-title":"Int. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"688","DOI":"10.3109\/17453670209178038","article-title":"Mechanical characteristics of antibiotic-laden bone cement","volume":"6","author":"Armstrong","year":"2002","journal-title":"Acta Orthop. Scand."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.55095\/achot2013\/011","article-title":"Microbial and pharmacological characteristics of VancogenX","volume":"1","author":"Gallo","year":"2013","journal-title":"Acta Chir. Orthop. Traumatol. Cech."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Schmolders, J., Hischebeth, G.T., Friedrich, M.J., Randau, T.M., Wimmer, M.D., Kohlhof, H., Molitor, E., and Gravius, S. (2014). Evidence of MRSE on a gentamicin and vancomycin impregnated polymethyl-methacrylate (PMMA) bone cement spacer after two-stage exchange arthroplasty due to periprosthetic joint infection of the knee. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-144"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"376","DOI":"10.7326\/0003-4819-97-3-376","article-title":"Treatment of infections due to methicillin-resistant staphylococcus aureus","volume":"3","author":"Watanakunakorn","year":"1982","journal-title":"Ann. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/j.arth.2016.11.042","article-title":"Superficial vancomycin coating of bone cement in orthopedic revision surgery: A safe technique to enhance local antibiotic concentrations","volume":"5","author":"Amerstorfer","year":"2017","journal-title":"J. Arthroplast."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1080\/17453670610012719","article-title":"Antibiotic-impregnated PMMA hip spacers: Current status","volume":"4","author":"Anagnostakos","year":"2006","journal-title":"Acta Orthop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1002\/jbm.b.30171","article-title":"In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic-loaded acrylic bone cement spacers","volume":"2","author":"Anagnostakos","year":"2005","journal-title":"J. Biomed. Mater. Res. B Appl. Biomater."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1086\/605572","article-title":"Vancomycin in combination with other antibiotics for the treatment of serious methicillin-resistant staphylococcus aureus infections","volume":"7","author":"Deresinski","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1002\/jor.20214","article-title":"High concentration and bioactivity of vancomycin and aztreonam eluted from simplex cement spacers in two-stage revision of infected hip implants: A study of 46 patients at an average follow-up of 107 days","volume":"8","author":"Hsieh","year":"2006","journal-title":"J. Orthop. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/00003086-199103000-00038","article-title":"Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement","volume":"264","author":"Kuechle","year":"1991","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/S0883-5403(99)90128-6","article-title":"The in vitro elution characteristics of antibiotic-loaded CMW and palacos-R bone cements","volume":"2","author":"Penner","year":"1999","journal-title":"J. Arthroplast."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/00003086-199311000-00040","article-title":"Antibiotic impregnated bone cement in total hip arthroplasty: An in vivo comparison of the elution properties of tobramycin and vancomycin","volume":"296","author":"Brien","year":"1993","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S0883-5403(99)90061-X","article-title":"The use of vancomycin and tobramycin in acrylic bone cement: Biomechanical effects and elution kinetics for use in joint arthroplasty","volume":"3","author":"Klekamp","year":"1999","journal-title":"J. Arthroplast."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.orthres.2004.03.003","article-title":"An articulated antibiotic spacer used for infected total knee arthroplasty: A comparative in vitro elution study of simplex and palacos bone cements","volume":"1","author":"Stevens","year":"2005","journal-title":"J. Orthop. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3724","DOI":"10.1016\/j.arth.2020.06.045","article-title":"Is dual antibiotic-loaded bone cement more effective and cost-efficient than a single antibiotic-loaded bone cement to reduce the risk of periprosthetic joint infection in aseptic revision knee arthroplasty?","volume":"35","author":"Vaquero","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Blersch, B., Barthels, M., Schuster, P., and Fink, B. (2023). A low rate of periprosthetic infections after aseptic knee prosthesis revision using dual-antibiotic-impregnated bone cement. Antibiotics, 12.","DOI":"10.3390\/antibiotics12091368"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/0732-8893(86)90147-1","article-title":"In vitro evaluation of clindamycin in combination with oxacillin, rifampin, or vancomycin against staphylococcus aureus","volume":"2","author":"Ho","year":"1986","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.diagmicrobio.2005.02.015","article-title":"Comparative in vitro activities of daptomycin, linezolid, and quinupristin\/dalfopristin against gram-positive bacterial isolates from a large cancer center","volume":"3","author":"Smith","year":"2005","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_42","unstructured":"K\u00fchn, K.D., Lieb, E., and Berberich, C. (2016). PMMA bone cement: What is the role of local antibiotics. Matrise Orthopaedic, Proceeding of N\u00b0243, Commission Paritaire 1218T86410, Heraeus."},{"key":"ref_43","first-page":"822","article-title":"Guidelines on antimicrobial therapy in situations of periprosthetic THR infection","volume":"7","author":"Frommelt","year":"2004","journal-title":"Orthopade"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Cherednichenko, K., Sayfutdinova, A., Rimashevskiy, D., Malik, B., Panchenko, A., Kopitsyna, M., Ragnaev, S., Vinokurov, V., Voronin, D., and Kopitsyn, D. (2023). Composite bone cements with enhanced drug elution. Polymers, 15.","DOI":"10.3390\/polym15183757"},{"key":"ref_45","first-page":"17","article-title":"Antimicrobial activity of gentamicin and vancomycin combination in joint fluids after antibiotic-loaded cement spacer implantation in two-stage revision surgery","volume":"27","author":"Benini","year":"2014","journal-title":"J. Chemother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s15010-006-5039-2","article-title":"In vitro inhibition of coagulase-negative staphylococci by vancomycin\/aminoglycoside-loaded cement spacers","volume":"2","author":"Streuli","year":"2006","journal-title":"Infection"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1007\/s00132-009-1450-6","article-title":"Diagnosis and treatment of foreign-body-associated infection in orthopaedic surgery","volume":"9","author":"Frommelt","year":"2009","journal-title":"Orthopade"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.injury.2017.08.040","article-title":"Fracture-related infection: A consensus on definition from an international expert group","volume":"3","author":"Metsemakers","year":"2018","journal-title":"Injury"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.1007\/s11999-008-0611-y","article-title":"Two-stage cementless revision of infected hip endoprostheses","volume":"7","author":"Fink","year":"2009","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1622","DOI":"10.1016\/j.arth.2014.02.032","article-title":"Risk stratified usage of antibiotic-loaded bone cement for primary total knee arthroplasty: Short term infection outcomes with a standardized cement protocol","volume":"8","author":"Qadir","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1128\/AAC.40.6.1534","article-title":"Vancomycin-gentamicin synergism revisited: Effect of gentamicin susceptibility of methicillin-resistant staphylococcus aureus","volume":"6","author":"Mulazimoglu","year":"1996","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1128\/AAC.4.2.120","article-title":"Synergism of vancomycin-gentamicin and vancomycin-streptomycin against enterococci","volume":"2","author":"Watanakunakorn","year":"1973","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1128\/AAC.22.5.915","article-title":"Effects of a vancomycin-rifampin combination on enterococci","volume":"5","author":"Watanakunakorn","year":"1982","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Hansen, E., and K\u00fchn, K.D. (2022). Essentials of Cemented Knee Arthroplasty, Springer.","DOI":"10.1007\/978-3-662-63113-3"},{"key":"ref_55","first-page":"290851","article-title":"Antibiotic loaded cement in orthopaedic surgery: A review","volume":"2011","author":"Bistolfi","year":"2011","journal-title":"Int. Sch. Res. Not. Orthop."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3141","DOI":"10.1007\/s11999-011-1937-4","article-title":"Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses","volume":"11","author":"Fink","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3109\/17453670902884700","article-title":"Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo","volume":"2","author":"Anagnostakos","year":"2009","journal-title":"Acta Orthop."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"29","DOI":"10.7150\/jbji.16067","article-title":"Therapeutic use of antibiotic-loaded bone cement in the treatment of hip and knee joint infections","volume":"1","author":"Anagnostakos","year":"2017","journal-title":"J. Bone Jt. Infect."},{"key":"ref_59","first-page":"380","article-title":"Different microbial biofilm formation on polymethylmethacrylate (PMMA) bone cement loaded with gentamicin and vancomycin","volume":"6","author":"Benini","year":"2011","journal-title":"Anaerobe"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"333","DOI":"10.3944\/AOTT.2014.3140","article-title":"Investigation of mechanical strength of teicoplanin and ciprofloxacin impregnated bone cement on day 1 and day 15","volume":"3","author":"Golge","year":"2014","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1016\/j.arth.2019.03.008","article-title":"Comparative study of antibiotic elution profiles from alternative formulations of polymethylmethacrylate bone cement","volume":"34","author":"Meeker","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Krampitz, B., Steiner, J., Trampuz, A., and K\u00fchn, K.-D. (2023). Voriconazole Admixed with PMMA-Impact on Mechanical Properties and Efficacy. Antibiotics, 12.","DOI":"10.3390\/antibiotics12050848"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s10856-015-5388-4","article-title":"Not all approved antibiotic-loaded PMMA bone cement brands are the same: Ranking using the utility materials selection concept","volume":"1","author":"Lewis","year":"2015","journal-title":"J. Mater. Sci. Mater. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1080\/17453670610012700","article-title":"Estimation of the optimum loading of an antibiotic powder in an acrylic bone cement: Gentamicin sulfate in SmartSet HV","volume":"4","author":"Lewis","year":"2006","journal-title":"Acta Orthop."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Humez, M., Domann, E., Thormann, K.M., F\u00f6lsch, C., Strathausen, R., Vogt, S., Alt, V., and K\u00fchn, K.-D. (2023). Daptomycin-Impregnated PMMA Cement against Vancomycin-Resistant Germs: Dosage, Handling, Elution, Mechanical Stability, and Effectiveness. Antibiotics, 12.","DOI":"10.20944\/preprints202310.0589.v1"},{"key":"ref_66","unstructured":"K\u00fchn, K.D. (2018). Spacer management. Management of Periprosthetic Joint Infection. A Global Perspective on Diagnosis, Treatment Options, Prevention Strategies and Their Economic Impact, Springer."},{"key":"ref_67","first-page":"804","article-title":"Liquid gentamicin in bone cement spacers: In vivo antibiotic release and systemic safety in two-stage revision of infected hip arthroplasty","volume":"3","author":"Hsieh","year":"2009","journal-title":"J. Trauma"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.arth.2008.01.131","article-title":"Liquid gentamicin and vancomycin in bone cement: A potentially more cost-effective regimen","volume":"1","author":"Hsieh","year":"2009","journal-title":"J. Arthroplast."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"578251","DOI":"10.1100\/2012\/578251","article-title":"Daptomycin: Local application in implant-associated infection and complicated osteomyelitis","volume":"2012","author":"Rosslenbroich","year":"2012","journal-title":"Sci. World J."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jchromb.2005.04.015","article-title":"LC\/MS\/MS measurement of gentamicin in bovine plasma, urine, milk, and biopsy samples taken from kidneys of standing animals","volume":"821","author":"Heller","year":"2005","journal-title":"J. Chromatogr. B Analyt. Technol. Biomed. Life Sci."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/8\/721\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:28:09Z","timestamp":1760110089000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/13\/8\/721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":70,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["antibiotics13080721"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics13080721","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}