{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T04:16:40Z","timestamp":1780719400780,"version":"3.54.1"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, typically managed through a two-stage revision protocol involving antibiotic-loaded spacers. This study aimed to evaluate the clinical outcomes and safety of a new multiple high-dose antibiotic-loaded cement (MHDALC) spacer against alternative classical antibiotic combinations for Gram-positive PJI. In this retrospective observational study of 102 patients (30 MHDALC vs. 72 control), the MHDALC cohort received spacers prepared with commercial cement (1 g clindamycin and 1 g gentamicin per 40 g) supplemented with manual additions of 4 g vancomycin and 2 g ceftazidime per 40 g of cement, while the control group received the same commercial cement supplemented with 4 g of vancomycin alone. Treatment failure was significantly lower in the MHDALC group (6.6%) compared to the control group (20.8%; p = 0.005). Furthermore, the time to second-stage reimplantation was drastically reduced in the MHDALC cohort (9.1 vs. 17.8 weeks; p = 0.001). Despite the substantially higher antibiotic load, no significant differences were observed regarding mechanical or surgical complications between the two groups (p = 1.00). In conclusion, the use of MHDALC spacers is an effective and safe strategy for treating Gram-positive PJI, significantly improving eradication rates and accelerating the transition to definitive reconstruction without compromising structural integrity.<\/jats:p>","DOI":"10.3390\/microorganisms14040768","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:33:33Z","timestamp":1774622013000},"page":"768","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Efficacy and Safety of Multiple High-Dose Antibiotic-Loaded Cement Spacers in the Two-Stage Revision of Gram-Positive Periprosthetic Joint Infection"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8876-6868","authenticated-orcid":false,"given":"Miguel","family":"M\u00e1rquez-G\u00f3mez","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4109-3373","authenticated-orcid":false,"given":"Lourdes","family":"Prats-Peinado","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Antonio Matas","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar","family":"S\u00e1nchez-Somolinos","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7607-5848","authenticated-orcid":false,"given":"Mar\u00eda","family":"Guembe","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8785-2278","authenticated-orcid":false,"given":"Javier","family":"Vaquero","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Medicine Department, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7588-1880","authenticated-orcid":false,"given":"Pablo","family":"Sanz-Ruiz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"},{"name":"Medicine Department, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"ref_1","first-page":"144","article-title":"Future clinical and economic impact of revision total hip and knee arthroplasty","volume":"89","author":"Kurtz","year":"2007","journal-title":"J. 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