Unveiling the Landscape of Vancomycin in Periprosthetic Joint Infections: A Comprehensive Bibliometric Analysis

Unveiling the Landscape of Vancomycin in Periprosthetic Joint Infections: A Comprehensive Bibliometric Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unveiling the Landscape of Vancomycin in Periprosthetic Joint Infections: A Comprehensive Bibliometric Analysis Yuting Yang, Ke Lv, Hongbo Li, Aidi Zhao, Yong Ding, Jinxue Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7244813/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Periprosthetic joint infection (PJI) is a devastating adverse complication after joint replacement surgery. Vancomycin is crucial in treating PJI but presents unique challenges. Despite extensive research, a comprehensive bibliometric analysis is missing. This study aims to identify key contributors, evaluate current research, and highlight major scientific issues. Methods We retrieved studies on vancomycin and PJI from the Web of Science Core Collection database, gathering data on publications, authors, citations, publication year, h-index, references, country/region, journal, and keywords. Bibliometric and visual analyses were conducted using R-bibliometrix, VOSviewer, and CiteSpace. Results The analysis included 451 publications from 725 institutions in 43 countries/regions from 2010 to 2025, showing a clear growth trend in annual publications. The United States contributed the most (172, 39.2%), with the Mayo Clinic leading in studies (28, 6.21%). Cao L had the highest number of publications, while Parvizi J received the most citations. The Journal of Arthroplasty was the leading journal in this field. Current research on vancomycin in PJI focuses on improving localized application and new drug delivery systems to tackle biofilm infections and antibiotic resistance. Additionally, burden management has emerged as a significant research area. Conclusion This study summarizes publications characteristics and identifies influential countries, institutions, authors, journals, and trends related to vancomycin use in PJI. The findings offer researchers valuable insights and help clinicians improve diagnostic and therapeutic services. Bibliometric analysis Periprosthetic joint infection Vancomycin Biofilm Antibiotic resistance. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Introduction Periprosthetic joint infection (PJI) refers to an infection occurring at the site of an artificial joint implant, affecting both the prosthetic joint and the adjacent tissues[ 57 ]. It is considered one of the most devastating complications following total joint arthroplasty, significantly affecting patient morbidity, healthcare costs, and long-term outcomes. The incidence of PJI is about 1% after total hip arthroplasty (THA) and 1–2% after total knee arthroplasty (TKA)[16; 36]. Furthermore, PJI is responsible for 14.8% of revision cases in hip joints and 25.2% in knee joints[ 34 ]. Its rising incidence is linked to increasing obesity, diabetes, and other comorbidities, as well as the growing number of arthroplasties performed[ 34 ]. PJI negatively impacts quality of life, leads to longer hospital stays, extended antibiotic treatments, and multiple surgeries, creating significant health and economic challenges[ 35 ]. Managing prosthetic joint infections (PJI) typically requires surgery and antimicrobial therapy to eliminate the infection while maintaining joint function[ 42 ]. Nevertheless, the rising prevalence of antimicrobial resistance and the formation of microbial biofilms on prosthetic surfaces present substantial challenges to effective treatment. Vancomycin, a glycopeptide antibiotic discovered in the 1950s, is vital for treating severe Gram-positive infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (CoNS), due to its unique ability to inhibit cell wall synthesis by binding to peptidoglycan precursors[3; 62]. In the context of periprosthetic joint infection, coagulase-negative Staphylococcus species, particularly Staphylococcus epidermidis, are the most commonly identified pathogens, responsible for approximately 37% of cases, followed by Staphylococcus aureus and Cutibacterium acnes[ 19 ]. Vancomycin is crucial for treating these infections due to its broad-spectrum efficacy and ability to penetrate bone and joint tissues. It is used in various treatment methods, such as systemic administration and antibiotic-loaded bone cement spacers, achieving over 85% success in initial two-stage revision procedures when combined with other antibiotics like Ceftazidime[ 48 ]. Despite its critical role in PJI management, vancomycin faces challenges like toxicity, resistance, and limited effectiveness against biofilms and culture-negative infections. Systemic use can cause nephrotoxicity, with up to 32% incidence in continuous intravenous infusions[ 71 ]. Its efficacy is notably reduced against biofilm-encased bacteria, with biofilm-associated MRSA showing up to 1,000 times more resistance than planktonic cells[ 61 ]. Consequently, research is needed to tackle resistance, optimize dosing, and improve delivery methods for better PJI management. Bibliometric analysis uses statistical methods to explore relationships between published articles and their data, offering insights into the intellectual structure and evolution of research fields[ 5 ]. It is essential for identifying trends, fostering collaboration, and guiding future research. The study conducted by Ma et al. utilized a meta-analysis in conjunction with bibliometric analysis to ascertain the incidence of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) and to explore the prevailing issues associated with TKA-related PJI [ 45 ]. Similarly, Pei et al. employed bibliometric analysis to examine the current status, developmental trends, and primary focus areas in prosthetic joint infection research from 2013 to 2023[ 40 ]. To our knowledge, no bibliometric analysis has been done on vancomycin use in periprosthetic joint infections. This study aims to quantitatively analyze related publications, identify key contributors, assess the research landscape, and highlight major scientific challenges. The findings are expected to provide valuable insights for clinicians and researchers, promoting further investigation. 2. Methods 2.1. Data sources and search strategy In this study, data pertaining to the application of vancomycin in periprosthetic joint infection were extracted from the Science Citation Index Expanded (SCI-E) within the Web of Science Core Collection (WoSCC). Recognized as one of the most authoritative and influential databases, WoSCC encompasses 18,000 journals across 256 disciplinary categories and is frequently utilized in bibliometric analyses due to its comprehensive information[6; 38]. The literature search was conducted on July 6, 2025, employing a search strategy focused on topics related to vancomycin and periprosthetic joint infection. The specified search strategy was TS = ("Periprosthetic joint infection" OR "Prosthetic joint infection") AND TS = (Vancomycin). To ensure data accuracy, the literature search was completed within a single day. The study's temporal scope spans 15 years, from January 1, 2010, to July 6, 2025. The document types were restricted to research articles and reviews, and the publication language was limited to English. The literature search process was independently conducted by two researchers to ensure reliability. 2.2. Data selection and extraction The two researchers critically assessed the inclusion criteria within the context of uncertainties surrounding the relevance of vancomycin application in periprosthetic joint infections. Following the exclusion of duplicates, irrelevant literature, documents with incomplete information—such as those lacking essential keywords that impeded analysis—as well as retractions, errata, conference papers, patents, newspapers, and non-research outputs, a total of 451 documents were selected. The comprehensive search process is illustrated in Fig. 1 . The raw data file formats were extracted from the Web of Science Core Collection for subsequent analysis. The following data were extracted from the selected publications: title, year of publication, author, country/region, institution, journal (including the journal impact factor for 2024), H-index, references, and keywords. Upon obtaining the data, we manually eliminated duplicate authors and corrected misspelled elements. 2.3 Data analysis Bibliometrix version 4.3.0 ( https://www.bibliometrix.org ), an R package that provides functions for quantitative research in bibliometrics and scientometrics, was utilized in this study[ 39 ]. Specifically, the Bibliometrix R package was employed to automate the transformation and analysis of bibliographic information for the selected publications. GraphPad Prism version 10.1.2 (GraphPad Inc, San Diego, CA, USA) was employed for the generation of graphical representations. This included line charts depicting the annual number of publications, citation counts, and H-index, as well as bar charts illustrating the cumulative number of publications per year. VOSviewer, a prominent scientometric network analysis tool developed by the Center for Science and Technology Research, is extensively utilized for organizing and visualizing bibliometric data[ 80 ]. In this study, VOSviewer (version 1.6.20) was utilized to generate visual graphs and to analyze collaborations among countries/regions, institutions, and authors, as well as to identify the most co-cited journals and frequently co-occurring keywords. CiteSpace, a Java-based application developed by Professor Chaomei Chen, serves as another visualization instrument for bibliometric and comparative analysis[ 13 ]. In this research, CiteSpace (version 6.4.R1) facilitated visual analysis of the knowledge domain and emerging trends through cluster analysis, dual-map overlay, timeline view, and detection of citation bursts in keywords and references. 3. Results 3.1. Study selection As depicted in Fig. 1 , an initial search of the WoSCC database on vancomycin in prosthetic joint infections found 582 records, with no duplicates or irrelevant entries. After excluding 16 records outside the 2010–2025 timeframe and 5 non-English records, the focus was narrowed to research articles and reviews, eliminating 10 more records. This left 451 publications for final analysis. 3.2. Annual quantitative distribution and characteristics of publications Figure 2 A shows a rise in publications on vancomycin in periprosthetic joint infections, with a steady increase from 2010 to 2019, a slight dip until 2021, and then a consistent rise, peaking at 63 publications in 2024, or 13.97% of the total. In the first half of 2025, publications have already exceeded half of 2024's total. Figure 2 B shows a steady rise in publications from 2010 to 2025. Figure 2 C highlights that from 2010 to 2022, articles averaged over two citations annually, and the H-index increased from 3 in 2010 to 24 in 2019, indicating growing interest in vancomycin's role in treating periprosthetic joint infections. 3.3. Distribution and cooperation of countries/regions From 2010 to 2025, 43 countries contributed to this research. Table 1 lists the top 12 contributors, with the U.S. leading at 176 publications (39.2%), followed by China with 83 (18.4%), and Germany with 46 (10.2%). The U.S. also leads in citations with 4,755, followed by China with 1,227, and Germany with 1,144. Additionally, the H-index rankings are topped by the United States (36), followed by China (20) and Italy (14), highlighting the U.S.'s leading role in vancomycin research for prosthetic joint infections. Figure 3 A shows a co-authorship network map, with countries grouped into four clusters by collaboration level. The USA has the strongest international network, notably with China, Germany, and England. Germany also collaborates closely with England and Switzerland. Table 1 The top 12 most productive countries regarding vancomycin in periprosthetic joint infection research from 2010 to 2025 Rank Country Counts Percentage Total citations H-Index 1 USA 176 39.02 4755 36 2 China 83 18.40 1227 20 3 Germany 46 10.20 1141 14 4 France 26 5.76 674 12 5 Spain 26 5.76 813 14 6 England 19 4.21 779 12 7 Austria 15 3.33 204 8 8 Canada 15 3.33 360 9 9 Switzerland 14 3.10 981 10 10 Australia 12 2.66 331 7 10 Italy 12 2.66 129 6 10 Japan 12 2.66 115 5 Table 2 The top 10 most productive institutions regarding vancomycin in periprosthetic joint infection research from 2010 to 2025 Rank Institution Country Counts Percentage Total citations H-Index 1 Mayo Clinic USA 28 6.21 724 13 2 Xinjiang Medical University China 19 4.21 251 9 3 Rothman Institute USA 18 3.99 756 13 4 Thomas Jefferson University USA 18 3.99 730 13 5 University Of California System USA 15 3.33 441 8 6 Institut National De La Sante Et De La Recherche Medicale Inserm France 13 2.88 240 9 7 Chang Gung Memorial Hospital China 12 2.66 352 8 8 University System Of Ohio USA 11 2.44 531 9 9 Ohio State University USA 10 2.22 476 8 10 Hosp Special Surg USA 9 2.00 291 6 3.4. Distribution and cooperation of institution From 2010 to 2025, 725 institutions researched vancomycin in periprosthetic joint infections. Table 1 highlights the top 10 institutions by publication volume, with the Mayo Clinic leading at 28 publications (6.21%), followed by Xinjiang Medical University with 19 (4.21%), and both the Rothman Institute and Thomas Jefferson University with 18 each (3.99%). The Rothman Institute, Thomas Jefferson University, and Mayo Clinic also topped the citation list with 756, 730, and 724 citations respectively, all sharing the highest H-index of 13. Figure 3 B shows a co-authorship network map of 51 institutions with more than three publications, featuring 352 collaborations across six clusters, each marked by different colors. The Mayo Clinic in the USA has the strongest international collaboration network, while the University of Southampton and Rush University also show significant partnerships in this research field. 3.5. Distribution and cooperation of authors of publications From 2010 to 2025, 2,425 authors have contributed to vancomycin research in periprosthetic joint infection. According to Price’s Law, the core group of authors, those with four or more publications, includes 28 individuals. Table 3 lists the top 10 authors by publication count, with Cao L leading at 18 (3.99%), followed by Parvizi J with 13 (2.88%), and Patel R with 11 (2.44%). Parvizi J has the most citations at 613, followed by Tan Tl with 288, Cao L with 249, and Patel R with 205. Cao L also has the highest H-index (9), G-index (15), and M-index (1), indicating a significant impact in this research area. Figure 3 C shows a co-authorship network for authors with over two publications, involving 103 institutions and 816 collaborations, divided into six color-coded clusters. Patel R has the broadest international network, while Cao L and Parvizi J also have strong collaborations. Figure 3 D displays a three-field plot linking countries, authors, and affiliations. The United States leads in connections with authors (12/20) and affiliations (10/20), followed by China (authors = 10/20, affiliations = 7/20). Patel R and Parvizi J are connected to China, whereas Cao L, Mu Wb, Wang Y, and Tan Tl are linked to the United States. Table 3 The top 10 most productive authors regarding vancomycin in periprosthetic joint infection research from 2010 to 2025 Rank Author Counts Percentage Total citations H-Index G-Index M-Index 1 Cao L 18 3.99 249 9 15 1 2 Parvizi J 13 2.88 613 9 13 0.643 3 Patel R 11 2.44 205 7 11 0.438 4 Stoodley P 8 1.77 160 7 8 0.7 5 Esteban J 7 1.55 199 7 7 0.538 6 Ferry T 7 1.55 191 7 7 0.7 7 Schwarzkopf R 7 1.55 172 6 7 0.75 8 Tan Tl 7 1.55 288 6 7 0.6 9 Zhang X 7 1.55 156 6 7 0.857 10 Wang Y 7 1.55 193 5 7 0.455 3.6. Analysis of source journals and co-cited journals Between 2010 and 2025, 451 references on vancomycin in prosthetic joint infections were published in 148 journals. Table 4 lists the top 12 journals by publication count, impact factors (IF), and JCR quartiles. The Journal of Arthroplasty led with 64 publications (14.9%) and 1,521 citations, followed by Antibiotics-Basel with 31 publications (6.87%), and the Bone & Joint Journal with 18 publications (3.99%). Clinical Orthopaedics and Related Research had the highest average citations per paper. Nine of the top 12 journals were in the Q1 JCR division, and eight had an impact factor over three. Figure 5 A shows the connections among journals in vancomycin PJI research. Antibiotics-Basel leads in publication output over the past three years. The journals are divided into four co-citation clusters: red for joints and orthopedics, yellow for clinical bone and joint health, green for biomaterials and microbiology, and blue for microbial infection and treatment. A dual map overlay of the journals was used to visually analyze topic distribution, citation trends, and research center shifts. Figure 5 C shows green paths indicating that journals in molecular biology, genetics, healthcare, and nursing medicine are frequently cited by those in the medicine and clinical fields, with some cross-disciplinary citations. Table 4 The top 12 most productive journals regarding vancomycin in periprosthetic joint infection research from 2010 to 2025 Rank Journal title Records Percentage Total citations Average citation H-Index IF (2024) JCR (2024) 1 Journal Of Arthroplasty 64 14.19 1521 23.77 26 3.8 Q1 2 Antibiotics-Basel 31 6.87 161 5.19 8 4.6 Q1 3 Bone & Joint Journal 18 3.99 510 28.33 14 4.6 Q1 4 Bone & Joint Research 16 3.55 286 17.88 10 5.1 Q1 5 Clinical Orthopaedics And Related Research 14 3.10 827 59.07 13 4.4 Q1 6 Antimicrobial Agents And Chemotherapy 14 3.10 702 50.14 11 4.5 Q1 7 Journal Of Orthopaedic Research 11 2.44 491 44.64 8 2.3 Q2 8 Journal Of Orthopaedic Surgery And Research 9 2.00 93 10.33 4 2.8 Q1 9 Bmc Infectious Diseases 7 1.55 158 22.57 7 3.0 Q2 10 Journal Of Bone And Joint Surgery-American Volume 7 1.55 235 33.57 6 4.3 Q1 10 Hip International 7 1.55 39 5.57 4 1.1 Q3 10 Journal Of Clinical Medicine 7 1.55 54 7.71 3 2.9 Q1 3.7 Analysis of highly cited studies Table 5 ranks the top 10 most cited studies among 451 publications analyzed, all with over 100 citations and published between 2011 and 2022. Over half are from the United States, including two from the University of Rochester. The most cited study, "Skeletal Infections: Microbial Pathogenesis, Immunity, and Clinical Management[ 23 ]," published in 2022 by University of Rochester researchers in Nature Reviews Microbiology, received 374 citations. Table 5 Top 10 cited publications regarding vancomycin in periprosthetic joint infection research from 2010 to 2025 Rank Title Journal First author Institution Total citations Average citation 1 Skeletal infections: microbial pathogenesis, immunity and clinical management Nature Reviews Microbiology Masters, Elysia A. University of Rochester, USA 374 93.50 2 Two-stage Treatment of Hip Periprosthetic Joint Infection Is Associated With a High Rate of Infection Control but High Mortality Clinical Orthopaedics And Related Research Berend, Keith R. JIS Orthoped Inc, USA 299 23.00 3 2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions Journal Of Orthopaedic Research Schwarz, Edward M. University of Rochester, USA 208 29.71 4 Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections Biomed Research International Portillo, Maria Eugenia Centrode Investigacion Biomedica enRed, Spain 201 15.46 5 Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective? Antimicrobial Agents And Chemotherapy Peel, Trisha Monash University, Australia 198 14.14 6 Mortality During Total Hip Periprosthetic Joint Infection Journal Of Arthroplasty Natsuhara, Kyle University of California, USA 161 23.00 7 2019 John Charnley Award: Increased risk of prosthetic joint infection following primary total knee and hip arthroplasty with the use of alternative antibiotics to cefazolin Bone & Joint Journal Wyles, Cody C. Mayo Clinic, USA 120 17.14 8 Approach to Septic Arthritis American Family Physician Horowitz, Diane Northwell, USA 118 7.87 9 Evidence-Based Recommendations for Local Antimicrobial Strategies and Dead Space Management in Fracture-Related Infection Journal Of Orthopaedic Trauma Metsemakers, Willem-Jan University Hospital Leuven, Belgium 111 18.50 10 Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study Clinical Microbiology And Infection Triffault-Fillit, Claire CHU Lyon, France 102 14.57 3.8 Analysis of co-cited references A co-citation analysis was performed to explore the interconnections within the literature and highlight the evolving scientific landscape. The study found 10,192 co-cited references related to vancomycin use in prosthetic joint infections. Table 6 lists the top 10 highly co-cited references, published between 2004 and 2018, with eight from the U.S. and two from Switzerland and Spain. The most cited work was "Diagnosis and Management of Prosthetic Joint Infection" by Osmon Douglas R (2013) with 88 citations, followed by Zimmerli W's "Current Concepts: Prosthetic-Joint Infections" (2004) with 85 citations, and Kurtz Steven M's "Economic Burden of Periprosthetic Joint Infection in the United States" (2012) with 75 citations. Figure 5 A shows a network of co-cited references, highlighting "Osmon DR (2013)," "Heckmann ND (2019)," and "Kheir MM (2015)" as frequently co-cited in vancomycin and prosthetic joint infection research. Cluster analysis, with a Q value of 0.8148 and S value of 0.9193, identified 13 significant clusters, five of which are prominent: “intrawound vancomycin,” “orthopedic infection,” “rat model,” “high-dose antibiotic-loaded bone cement,” and “antibiotic resistance.” Fig. 5 C shows a timeline of distinct research clusters, highlighting the emerging cluster of "intrawound vancomycin," "rat model," and "radiation crosslinking" as current research frontiers. Figure 5 D lists the top 25 references with significant citation bursts from 2010 to 2025, with Osmon DR's 2013 study having the highest burst strength of 12.95. This study offers recommendations for diagnosing and managing periprosthetic joint infection[ 21 ]. Recent contributions by Premkumar A, Dagneaux L, Park KJ, Parkinson B, Buchalter DB, and Feder OI have spurred increased research interest in vancomycin's role in periprosthetic joint infection. Table 6 The top 10 co-cited references for vancomycin in periprosthetic joint infection research from 2010 to 2025 Rank Title Journal First author Institution Year Citations 1 Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America Clinical Infectious Diseases Osmon, Douglas R. Mayo Clinic, USA 2013 88 2 Current concepts: Prosthetic-joint infections New England Journal Of Medicine Zimmerli, W University of Basel, Switzerland 2004 85 3 Economic burden of periprosthetic joint infection in the United States Journal Of Arthroplasty Kurtz, Steven M. Drexel University, USA 2012 75 4 Prosthetic Joint Infection Clinical Microbiology Reviews Tande, Aaron J. Mayo Clinic, USA 2014 50 5 Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2003 Journal Of Bone And Joint Surgery-American Volume Kurtz, Steven Drexel University, USA 2007 46 6 The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria Journal Of Arthroplasty Parvizi, Javad Thomas Jefferson University, USA 2018 41 7 Periprosthetic joint infection: The incidence, timing, and predisposing factors Clinical Orthopaedics And Related Research Pulido, Luis Thomas Jefferson University, USA 2008 39 8 Periprosthetic joint infection Lancet Kapadia, Bhaveen H. SUNY Downstate Health Sciences University, USA 2016 36 9 Infection Associated with Prosthetic Joints New England Journal Of Medicine Del Pozo, Jose L. University of Navarra, Spain 2009 34 10 Infection burden for hip and knee arthroplasty in the United States Journal Of Arthroplasty Kurtz, Steven M. Drexel University, USA 2008 34 3.9 Analysis of keywords Keywords are often used in references to summarize research themes, and analyzing their co-occurrence helps identify key areas and future research directions. Figures 6 A and 6 B show the network and density maps of co-occurring keywords. The top ten keywords are vancomycin, "periprosthetic joint infection," "prosthetic joint infection," hip, arthroplasty, "total knee arthroplasty," revision, antibiotics, biofilm, and debridement. Keywords appearing more than five times were grouped into five clusters, each with a unique color representing different research directions (see Fig. 6 A). The largest cluster, in red, includes 40 keywords like "vancomycin," "prosthetic joint infection," "antibiotics," "biofilm," and "osteomyelitis." Cluster 2, in green, has 38 keywords, including "revision," "debridement," "management," "2-stage revision," and "total hip arthroplasty." Cluster 3 (blue) featured 37 keywords, including "periprosthetic joint infection" and "total knee arthroplasty." Cluster 4 (yellow) had 30 keywords like "gentamicin" and "staphylococcus aureus elution." Cluster 5 (purple) comprised 28 keywords such as "hip" and "arthroplasty." Keyword density maps illustrated these terms (Fig. 6 B), while CiteSpace showed their evolution over time (Fig. 6 C), with a Q-value of 0.3767 and an S-value of 0.6926. A total of 10 research clusters were identified, covering topics like "prosthetic joint infection," "knee arthroplasty," and "acute kidney injury." Recently, "knee arthroplasty" and "prosthetic joint infection" have been key research areas. Identifying burst keywords helps track research trends and predict future breakthroughs. Figure 7D shows the top 10 keywords with significant citation bursts, with "bone cement" leading at 4.98, followed by "tobramycin" at 4.60 and "daptomycin" at 4.11. "Implant retention" and "higher tissue concentrations" have recently become research focal points. 4. Disscussion In this study, we conducted a bibliometric and visual analysis to objectively interpret the literature concerning the application of vancomycin in periprosthetic joint infection. A total of 451 publications were identified in this field from 2010 to 2025, comprising 407 articles and 44 reviews. Our findings indicate a significant upward trend in the number of annual publications, with notable peaks in 2019 and 2024. The increasing trend indicates that the application of vancomycin in the context of periprosthetic joint infections has garnered heightened attention in recent years. Notably, 2019 marked a pivotal year in this domain, as it witnessed the first peak in citation counts and the highest observed H-index. The subsequent decline in citations and H-index over the past four years may be attributed to the temporal proximity of the data collection period. The volume of publications, citations, and H-index within a specific research field are recognized as critical indicators for evaluating the academic reputation and scientific research capabilities of a country or institution[ 72 ]. In this analysis, the United States emerged not only as the nation with the highest number of publications but also as the leader in citation counts and H-index. Furthermore, the United States demonstrated extensive international collaborative relationships with countries such as China, Germany, and the United Kingdom. These findings suggest that the United States plays a dominant role in advancing research in this area and may significantly influence its future trajectory. Regarding institutional contributions, while the Mayo Clinic and Xinjiang Medical University ranked first and second, respectively, in terms of the number of published papers, they did not demonstrate a significant advantage in citations and H-index. Except for the Mayo Clinic, collaboration among other institutions with high publication output was not sufficiently robust, highlighting the need for increased international multicenter cooperation to enhance the dissemination and academic impact of research findings. Co-authorship analysis can assist researchers in understanding the relationships between researchers in a specific area and identifying potential collaborations [ 18 ]. Among authors, Cao L distinguished themselves by having the highest number of publications, while Parvizi J was notable for achieving the highest number of citations, each excelling in their respective domains. Furthermore, Cao L and Parvizi J maintained a strong collaborative relationship within this research field. Their joint work revealed that higher preoperative synovial white blood cell counts were associated with successful outcomes in single-stage exchange arthroplasty or debridement, combined with antibiotics and implant retention with topical antibiotic infusion for PJI[ 52 ]. Furthermore, recent research has demonstrated that intraoperative sonication can effectively enhance culture yield and reduce the time to positivity in patients with periprosthetic joint infections (PJI), thereby facilitating targeted antibiotic therapy to improve treatment outcomes and promote antibiotic stewardship[ 53 ]. Patel R. is noted as the author with the most international collaborations in this field, with a primary focus on the pathogens, antibiotic drugs, and genomic studies associated with periprosthetic joint infections[12; 25; 67]. The evaluation of scholarly journals aids authors in selecting the most appropriate platform for publishing their research findings and provides researchers with suitable channels to stay informed about the latest advancements in a specific field. Generally, the influence of a journal is closely related to the impact of its articles, and the impact factor serves as an indicator to assess a journal's influence by measuring its citation rate, academic rigor, and the quality of its publications[41; 79]. The majority of high-output journals are classified as Q1, indicating that research conducted in this field holds significant scholarly value and is widely recognized. The Journal of Arthroplasty, Clinical Orthopaedics and Related Research, and Bone & Joint Research are recognized as the most influential journals in the domain of vancomycin application for periprosthetic joint infection. Among these, the Journal of Arthroplasty boasts the highest number of publications and the greatest H-index. Clinical Orthopaedics and Related Research leads in average citations per paper, while Bone & Joint Research possesses the highest impact factor among high-output journals. These journals provide scholars with enhanced access to cutting-edge research and facilitate the dissemination of their findings in this area. Notably, the Journal of Arthroplasty remains the preeminent academic journal in this field, as evidenced by journal clustering and co-citation analyses. This underscores its significant academic influence and its potential as a platform for advancing future research on vancomycin in PJI. Highly cited references are typically considered the most significant and influential contributions within a field. Among the top ten cited publications, the most highly cited work systematically investigated and summarized microbial pathogenesis, immunity, and clinical management in skeletal infections[ 47 ]. Berend et al. identified that the two-stage treatment for deep infections is associated with a significant mortality rate and a notable failure rate due to reinfection and the inability to proceed to the second stage of treatment in both primary and revision total hip arthroplasty[ 10 ]. Schwarz et al. discussed research priorities related to musculoskeletal infections, including distinctions between acute and chronic infections, host immunity, antibiotics, diagnosis, research limitations, and modifiable factors, during the 2018 International Consensus Meeting on Musculoskeletal Infection[ 22 ]. The study by Portillo et al. primarily reviewed the pathogenic role of Propionibacterium acnes in implant-associated infections, including those involving artificial joints[ 46 ]. Peel et al. conducted a study on the epidemiology and microbiological etiology of periprosthetic joint infection (PJI), revealing that in 63% of PJI cases, the microorganisms identified were resistant to the prophylactic antibiotics administered[ 70 ]. This finding suggests a diverse array of pathogens involved in the infection process. Natsuhara et al. reported a notably high mortality rate associated with total hip PJI, with a five-year mortality rate of 21.12%[ 37 ]. This highlights the critical need to address mortality risks when counseling patients who develop this complication. Wyles et al. demonstrated a 32% reduction in the risk of PJI when cefazolin was used for perioperative infection prevention, emphasizing the beneficial role of preoperative antibiotic allergy testing in increasing cefazolin utilization[ 15 ]. Horowitz et al. reviewed treatment strategies for septic arthritis, recommending vancomycin for Gram-positive cocci[ 28 ]. In cases where the Gram stain was negative but clinical suspicion of bacterial arthritis remained high, they suggested a combination of vancomycin with ceftazidime or aminoglycosides. Metsemakers et al. concentrated on elucidating the existing local antimicrobial strategies employed in the management of fracture-related infections, paralleling the extensive research conducted on local antimicrobial therapy for periprosthetic joint infections[ 76 ]. A prospective cohort study by Triffault-Fillit et al. indicated that the combination of vancomycin with broad-spectrum β-lactam antibiotics may be effective only in patients with late periprosthetic joint infections (defined as prosthesis implantation for more than 12 months)[ 14 ]. This finding suggests that the empirical use of broad-spectrum β-lactam antibiotics should be reevaluated in cases of late periprosthetic joint infections. Analyzing these highly cited articles offers perspectives and insights into the most influential contributions within the research domain of vancomycin in periprosthetic joint infections. Through co-citation reference analysis, the underlying trends in research literature categories over a specific period can be uncovered, with studies possessing high co-citation rankings often regarded as foundational research in the field[ 77 ]. Presented below are the top 10 co-cited references for research on vancomycin and prosthetic joint infections from 2010 to 2025. Osmon DR et al., as the most frequently co-cited reference from the Mayo Clinic, authored the clinical practice guidelines of the Infectious Diseases Society of America. These guidelines propose diagnostic and management strategies for periprosthetic joint infections and are intended for use by infectious disease specialists, orthopedic surgeons, and other healthcare professionals involved in patient care[ 20 ]. Another study conducted at the Mayo Clinic by Tande AJ et al. examined the reported risk factors and clinical manifestations of PJI, discussed its pathogenesis and the various microorganisms responsible for this severe infection, and outlined strategies for its treatment and prevention[ 1 ]. Kurtz SM et al. from Drexel University contributed three high-quality studies that primarily focused on the burden of hip and knee arthroplasty and periprosthetic joint infections[ 64 – 66 ]. Their 2007 research projected a 137% increase in total hip revision surgeries and a 601% increase in total knee revision surgeries between 2005 and 2030, providing a quantitative foundation for future policy decisions to address this rising demand. In 2008, research indicated that the infection rate for knee arthroplasty was 0.92%, which was notably higher than the 0.88% infection rate for hip arthroplasty. Additionally, there was an observed increase in the diagnosis of joint replacement surgeries as periprosthetic infections. A subsequent study conducted in 2012 examined the patient and clinical factors influencing the economic impact of periprosthetic joint infections in the United States. This study projected that the economic burden of prosthetic infections would significantly escalate due to the anticipated rise in demand for joint replacement surgeries over the following decade. Two studies from Thomas Jefferson University concentrated on the incidence, timing, risk factors, and diagnostic criteria associated with periprosthetic joint infections[31; 43]. A study from 2008 reported a periprosthetic joint infection rate of 0.7%, with 65% of infections occurring within the first year after joint replacement. Independent predictive factors for these infections included a higher American Society of Anesthesiologists score, morbid obesity, bilateral arthroplasty, knee arthroplasty, allogenic transfusion, postoperative atrial fibrillation, myocardial infarction, urinary tract infection, and prolonged hospitalization. In 2018, the institution's research advanced the diagnostic criteria for periprosthetic joint infections, achieving an enhanced sensitivity of 97.7% while maintaining a specificity of 99.5%, comparable to the benchmarks established by the International Consensus Meeting. Concurrently, research from other institutions has contributed significantly to this domain. Zimmerli et al. noted that despite advancements in technology reducing the incidence of periprosthetic joint infections (PJI), these infections continue to present substantial challenges in clinical management[ 74 ]. They provided a comprehensive summary of guidelines for accurate diagnosis and proposed an algorithm that includes appropriate medical and surgical interventions. Furthermore, a review by Kapadia BH et al. assessed the risk factors, preventive strategies, diagnostic approaches, clinical manifestations, and treatment modalities for prosthetic joint infections, indicating that the field of orthopedics could greatly benefit from improved methods in prevention, diagnosis, and treatment[ 11 ]. Del Pozo et al. highlighted that, based on current treatment protocols for periprosthetic joint infection following total hip arthroplasty, a two-stage exchange arthroplasty in conjunction with a four-week antibiotic therapy is a more appropriate choice[ 33 ]. These studies offer a comprehensive overview of the existing knowledge regarding the use of vancomycin in the treatment of periprosthetic joint infections, significantly contributing to the advancement of fundamental research in this domain. Emerging academic centers can be identified through the analysis of co-citation clusters, which reflect the core content and emerging topics within specific fields[ 60 ]. Cluster #0, labeled "intrawound vancomycin," was not only the largest cluster but also among the most recent in terms of temporal development within this field. Hanada M et al. examined the efficacy and adverse effects of high-dose topical vancomycin powder in preventing periprosthetic joint infections (PJI) in total knee arthroplasty and unicompartmental knee arthroplasty[ 49 ]. Their findings indicated that the intrawound application of vancomycin powder did not decrease the incidence of PJI and was significantly associated with aseptic wound complications. Consequently, the use of intrawound vancomycin powder for PJI prevention in primary total knee arthroplasty and unicompartmental knee arthroplasty is not recommended. Another noteworthy and relatively recent research cluster in this field is Cluster #2. Ji B et al. conducted a comparative study to evaluate the efficacy of one-stage revision surgery in patients with culture-negative periprosthetic joint infection (PJI), treated with intravenous vancomycin and alternating intra-articular injections of vancomycin and imipenem, versus those with culture-positive PJI, treated with pathogen-sensitive intravenous antibiotics[ 8 ]. The findings indicated that one-stage revision surgery, supplemented with direct intra-articular antibiotic administration, is effective in managing culture-negative PJI, achieving infection control rates comparable to those observed in culture-positive cases. Further investigation revealed that intra-articular administration of antibiotics such as vancomycin and imipenem during one-stage revision can result in high antibiotic concentrations in the synovial fluid, thereby addressing challenges related to compromised vascular supply and biofilm formation[ 7 ]. This alternative route of administration may represent a viable strategy for managing reinfected PJI following multiple previous surgical failures. In the recently identified #9 cluster, Corona PS et al. conducted an investigation into the outcomes of two-stage revision in patients with periprosthetic joint infection who were not considered for reimplantation[ 58 ]. Their findings indicated that excluding patients who did not undergo reimplantation resulted in a 9% overestimation of the success rate within this series, suggesting that the actual success rate of two-stage revision may be lower than previously reported. In newly published high-intensity burst studies, Premkumar A et al. examined the current burden of PJI in the United States, estimating that the total annual hospitalization costs associated with PJI could reach $ 1 billion by 2030[ 2 ]. Further analysis indicated that the increase in PJI costs was primarily due to the rising number of cases, underscoring the urgent need for effective prevention strategies to reduce the incidence of PJI following joint arthroplasty. In summary, based on co-citation and cluster analysis, there is a growing research focus on the use of vancomycin in periprosthetic joint infections. Notably, In recent years scholarly focus in this domain has primarily concentrated on the localized administration of vancomycin for the treatment of periprosthetic joint infections, the success rates of PJI revision surgeries, and the relationship with the treatment burden of PJI. This trend signifies the emergence of novel academic interests. An analysis of keywords has highlighted current research hotspots and frontiers within the field of vancomycin use in PJIs. The analysis revealed that the most frequently occurring keywords pertained to the application strategies of vancomycin and the eradication of biofilms in revision surgeries for periprosthetic infections of the hip or knee. These findings align with the results from analyses of highly cited literature, suggesting these are the most extensively researched subfields. The synthesis of keyword clustering information facilitated a precise delineation of the research focus and scope within the field[ 78 ]. Timeline analysis indicated that clusters such as #0 prosthetic joint infection, #1 knee arthroplasty, and #5 Staphylococcus epidermidis have persisted to the present. his analysis suggests that research on periprosthetic joint infections associated with Staphylococcus epidermidis following knee arthroplasty not only constitutes a foundational study in this domain but also holds promise for pioneering new research directions. Collectively, these research clusters illustrate a diverse array of potential investigative pathways, underscoring the complex nature of studies concerning the application of vancomycin in PJIs and the persistent necessity for innovative strategies to tackle this clinical issue. The burst analysis of keywords indicates that early research predominantly concentrated on diagnosis, antibiotic efficacy, and the use of bone cement in the context of vancomycin application in PJIs. Subsequently, the focus shifted towards the management of PJIs using spacers, as well as prevention and implant retention strategies. Presently, research is primarily centered on investigations related to achieving higher tissue concentrations of vancomycin. By examining these keywords, it becomes more feasible to systematically review the overarching developmental trends within the research field of vancomycin application in periprosthetic joint infection. Recent advancements in the application of vancomycin for addressing periprosthetic joint infection have markedly improved the effectiveness of both prevention and treatment strategies in revision surgeries. Vancomycin continues to serve as a fundamental component in the management of PJI, primarily due to its robust efficacy against Gram-positive pathogens, including MRSA and CoNS, both of which are commonly associated with biofilm-related infections[ 26 ]. The application of vancomycin in PJI has undergone significant evolution, with recent progress emphasizing the optimization of its delivery methods, pharmacokinetics, and therapeutic efficacy to effectively counteract the challenges posed by biofilm formation and antibiotic resistance[32; 59]. The integration of vancomycin with bone cement and localized drug delivery systems has consistently been a central focus of innovation in this field, addressing the limitations inherent in systemic antibiotic therapy, such as inadequate bone penetration and systemic toxicity. One of the most significant advancements in the field has been the incorporation of vancomycin-loaded bone cement in two-stage revision surgeries. This technique involves the application of an antibiotic-impregnated cement spacer during the initial stage, which not only provides mechanical stability but also facilitates the delivery of high local concentrations of vancomycin to effectively eradicate residual infections[ 50 ]. Empirical evidence indicates that vancomycin, particularly when combined with other antibiotics such as tobramycin or gentamicin, markedly reduces infection recurrence rates and enhances joint function following revision procedures[9; 56; 69]. Another innovative approach involves the localized administration of vancomycin, which ensures elevated concentrations at the infection site while minimizing systemic exposure and the risk of associated adverse effects. The study conducted by He JW et al. demonstrated that intra-articular infusion of vancomycin achieved sustained therapeutic concentrations in synovial fluid, which is crucial for the eradication of biofilm-embedded pathogens[ 27 ]. Their research indicated that an intra-articular injection of 0.5 g of vancomycin once daily, whether administered alone or in conjunction with intravenous administration, maintained effective trough concentrations in the synovial fluid, thereby improving therapeutic outcomes. A study indicated that a localized approach proved particularly beneficial in situations where systemic antibiotic therapy alone failed to adequately penetrate biofilms[ 59 ]. Furthermore, the intraoperative application of vancomycin powder represented a notable advancement in research, particularly in procedures such as debridement, implant retention, and two-stage revision arthroplasty. This technique demonstrated efficacy in reducing the incidence of periprosthetic joint infection by delivering high local concentrations of vancomycin directly to the surgical site, thereby inhibiting bacterial colonization and biofilm formation[ 73 ]. Fabio et al. introduced the use of vancomycin powder in conjunction with diluted povidone-iodine irrigation to decrease the incidence of PJI in high-risk patients undergoing total knee arthroplasty[ 17 ]. Their findings revealed a reduction in PJI incidence by 44.6% and 56.4% in high-risk and overall risk cohorts, respectively, following early primary total knee arthroplasty. Additionally, the study by Shiyu L et al. examined the effects of topical application of varying doses of vancomycin powder on PJI incidence[ 63 ]. The study identified that the application of 1g and 2g vancomycin powder during primary total knee arthroplasty was effective in preventing periprosthetic joint infection. In contrast, the use of 1g vancomycin powder was deemed more suitable for primary total hip arthroplasty, with the effectiveness of 2g vancomycin powder remaining uncertain[ 63 ]. Despite some evidence supporting the topical application of vancomycin powder in PJI prevention, the research findings are inconsistent and remain a subject of considerable debate[24; 54; 75]. The novel drug delivery systems are being developed to enhance the localized release of vancomycin in PJI. Notably, carbon fiber-reinforced polyetheretherketone implants with a sustained-release mechanism of vancomycin have shown significant therapeutic efficacy in primary revision surgeries[ 55 ]. Additionally, vancomycin-loaded niosomes incorporated into fast-disintegrating oral films represent an innovative advancement in antibiotic delivery systems. These systems facilitate targeted delivery of vancomycin to infected sites, improving its bioavailability and therapeutic efficacy while reducing systemic side effects. Furthermore, microfluidic techniques are being utilized to prepare niosomes with optimal size and encapsulation efficiency[ 4 ]. The application of microfluidic techniques for the preparation of niosomes with optimal size and encapsulation efficiency has further enhanced the viability of this approach for both oral and systemic applications[ 4 ]. Despite vancomycin's critical role in the management of prosthetic joint infections (PJIs), its use is fraught with challenges, particularly in the face of increasing antimicrobial resistance and the intricate nature of these infections. A major limitation of vancomycin in the treatment of PJIs is its suboptimal pharmacokinetic and pharmacodynamic properties in bone and joint tissues. Achieving therapeutic concentrations at the site of infection is difficult due to poor penetration into biofilms and the avascular characteristics of prosthetic materials[ 30 ]. This necessitates the administration of higher doses, thereby elevating the risk of nephrotoxicity and other adverse effects, which complicates patient management[ 68 ]. Furthermore, the empirical use of vancomycin, often commenced prior to pathogen identification, may result in inappropriate therapy and contribute to the development of resistance[ 29 ]. The absence of rapid diagnostic tools for the identification of causative pathogens and their resistance profiles further delays the initiation of targeted therapy[ 44 ]. Finally, the use of vancomycin bone cement may result in significant adverse reactions, including vancomycin flushing syndrome[ 51 ]. In summary, recent advancements in the application of vancomycin for periprosthetic joint infections (PJI) have markedly enhanced its therapeutic efficacy, particularly through localized delivery systems, optimized pharmacokinetics, and innovative formulations. These developments have effectively addressed the challenges associated with biofilm-related infections and antibiotic resistance, thereby improving patient outcomes in PJI cases. Future research should concentrate on refining dosing regimens, investigating combination therapies, and identifying patient-specific factors that may influence treatment success, ultimately facilitating the development of more personalized and effective management strategies. This study offers a comprehensive bibliometric analysis of vancomycin in periprosthetic joint infection, but it has limitations. It relied solely on the WOSCC database, which may not capture all relevant literature, although it is recognized for high-quality analyses. Additionally, the focus on English-language publications from 2010 to 2025 excluded significant Chinese literature and contributions from Chinese researchers, potentially affecting the findings. Ongoing updates to the database may also lead to variations in bibliometric data, and discrepancies in author affiliations could introduce further inconsistencies. Lastly, discrepancies in author institutional affiliations may introduce inconsistencies. 5. Conlusion This study employed bibliometric analysis and visualization techniques to comprehensively delineate and assess the global landscape of research, development trends, prominent research avenues, and emerging focal points related to the application of vancomycin in periprosthetic joint infections. Despite minor fluctuations in the annual publication output within this research domain, an overall upward trend in scholarly activity was discernible. Notably, the United States emerged as the leading contributor to this field, with the Mayo Clinic producing the highest number of studies. However, Professor Cao Li from China distinguished himself by authoring the largest number of publications, thereby making substantial contributions to the discipline. The Journal of Arthroplasty was identified as the most influential academic journal in this area, underscoring its significant role in advancing the field. An analysis of keywords and co-cited references illuminated potential trends, current research hotspots, and frontiers within the domain of vancomycin application in periprosthetic joint infections. Emerging research focal points primarily centered on optimizing localized application methods and further development in this area. Emerging research has predominantly concentrated on advancing localized application techniques and developing innovative drug delivery systems to enhance therapeutic efficacy, particularly in overcoming the challenges associated with biofilm infections and antibiotic resistance. Additionally, the management of the burden in this domain has emerged as a significant research focus. In our study, we examined current research trends concerning the use of vancomycin in periprosthetic joint infections, highlighting the effectiveness of local applications (such as bone cement, intra-articular injections, or powder), the benefits of novel drug delivery systems, and the existing challenges. Our comprehensive review of the current knowledge landscape in this field provides researchers with essential insights, facilitating the identification of potential key research directions and enabling clinicians to deliver improved diagnostic and therapeutic services to patients. Declarations Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Author Contribution Yuting Yang: Writing – original draft, Visualization, Validation, Methodology, Formal analysis, Data curation. Ke Lv: Software, Visualization. Hongbo Li: Supervision, Visualization. Aidi Zhao: Visualization. Yong Ding: Writing – review & editing, Funding acquisition, Conceptualization. Jinxue Zhang: Writing – review & editing, Visualization, Software, Project administration, Methodology, Formal analysis, Data curation, Conceptualization. Data Availability The data that support the findings of this study are available from the corresponding author upon reasonable request. References Aaron JT, Robin P (2014) Prosthetic joint infection. 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Clinical microbiology and infection. the official publication of the European Society of Clinical Microbiology and Infectious Diseases Wang J, Chi Y, Yang B et al (2022) The application of biomaterials in osteogenesis: A bibliometric and visualized analysis. Front Bioeng Biotechnol 10:998257 Wei J, Tong K, Wang H, Wen Y, Chen L (2022) Dosage, Efficacy, and Safety of Intra-articular Vancomycin for Prophylaxis of Periprosthetic Joint Infection Caused by Methicillin-Resistant Staphylococcus aureus after Total Knee Arthroplasty in a Rat Model. Antimicrob Agents Chemother 66(2):e0164121 Werner Z, Andrej T, Ochsner PE (2004) Prosthetic-joint infections. The New England journal of medicine Wesam A, Caralee AB, Anastasia D et al (2023) Is Topical Vancomycin an Option? A Randomized Controlled Trial to Determine the Safety of the Topical Use of Vancomycin Powder in Preventing Postoperative Infections in Total Knee Arthroplasty, as Compared With Standard Postoperative Antibiotics. The Journal of arthroplasty Willem-Jan M, Austin TF, Moriarty TF et al (2019) Evidence-Based Recommendations for Local Antimicrobial Strategies and Dead Space Management in Fracture-Related Infection. Journal of orthopaedic trauma Yang L-j, Liangxiu H, Naxin L (2019) A new approach to journal co-citation matrix construction based on the number of co-cited articles in journals. Scientometrics Yuan C, Yu C, Sun Q et al (2023) Research on antibiotic resistance in Helicobacter pylori: a bibliometric analysis of the past decade. Front Microbiol 14:1208157 Zhang F, Wang R, Liu B, Zhang L (2022) A bibliometric analysis of autophagy in atherosclerosis from 2012 to 2021. Front Pharmacol 13:977870 Zhang Q, Xin X, Wang L (2022) A Bibliometric Analysis of 8271 Publications on Thyroid Nodules From 2000 to 2021. Front Endocrinol (Lausanne) 13:845776 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7244813","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495825363,"identity":"d3a5718b-0f9a-4897-869e-513d7e69dd7a","order_by":0,"name":"Yuting Yang","email":"","orcid":"","institution":"The Hongda Hospital of Jiamusi University","correspondingAuthor":false,"prefix":"","firstName":"Yuting","middleName":"","lastName":"Yang","suffix":""},{"id":495825364,"identity":"1aac7b8f-10b8-4f6d-9837-2aec0824f9dd","order_by":1,"name":"Ke Lv","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Ke","middleName":"","lastName":"Lv","suffix":""},{"id":495825365,"identity":"601785aa-6030-45dd-9e70-4d91e5ce55d9","order_by":2,"name":"Hongbo Li","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Hongbo","middleName":"","lastName":"Li","suffix":""},{"id":495825366,"identity":"a23d40e0-c0cc-49d0-b5a9-40d89cf0fd93","order_by":3,"name":"Aidi Zhao","email":"","orcid":"","institution":"The 963th Hospital of Chinese People's Liberation Army","correspondingAuthor":false,"prefix":"","firstName":"Aidi","middleName":"","lastName":"Zhao","suffix":""},{"id":495825367,"identity":"2abd5851-fc71-40cf-a016-386b4bac12ac","order_by":4,"name":"Yong Ding","email":"","orcid":"","institution":"Honghui Hospital, Xi’an Jiaotong University","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Ding","suffix":""},{"id":495825368,"identity":"ef8c2bdb-8da6-4a73-a0bd-81c26d39d432","order_by":5,"name":"Jinxue Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYDACCTDJxgOmPpCshXEGCVoggJmHGB3ys5ufPfzCwCdjLpFj+NimzJqBv707Aa8WxjnHzI1lgA6z7DljbJxzLp1B4szZDXi1MEskmElL/mPjMTjeYyad23aYwUAiF78WNon0b9ISQFsMDvOY/7YkRguPRI6Z5AcGiC3MjMRokZDIKZMGBbLBmWPFkj3n0nkI+kV+Rvo2yR8Mx+wNbiRv/PCjzFqOv70XvxYQAEbHMZjXiIsaBsYfDDVwLUTpGAWjYBSMgpEFALqoOxNymED8AAAAAElFTkSuQmCC","orcid":"","institution":"The 963th Hospital of Chinese People's Liberation Army","correspondingAuthor":true,"prefix":"","firstName":"Jinxue","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-07-29 15:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7244813/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7244813/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88644598,"identity":"01bb96fb-1738-4953-9d10-8ea9201b139a","added_by":"auto","created_at":"2025-08-08 16:20:32","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":688448,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the literature screening process.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7244813/v1/3ff623a87ba4f87b8958a7ee.jpg"},{"id":88645719,"identity":"df8d44b8-2a52-444b-bcd8-658551a70d89","added_by":"auto","created_at":"2025-08-08 16:28:32","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":449271,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGeneral information on annual publications.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) The global annual number of publications.\u003c/p\u003e\n\u003cp\u003e(B) The global annual number of cumulative publications.\u003c/p\u003e\n\u003cp\u003e(C) The global annual number of citations of the publications.\u003c/p\u003e\n\u003cp\u003e(D) The global annual H-index values of the publications.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7244813/v1/33df2895407367e995d0b9fa.jpg"},{"id":88645720,"identity":"659a56f5-43c0-4ce5-8cd4-b7febe633947","added_by":"auto","created_at":"2025-08-08 16:28:32","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":724715,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eVisualization map of countries, institutions and authors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe coauthorship network map of countries (A), institutions (B), and authors (C): the size of the nodes corresponds to the document counts; the lines suggest the connections between countries/institutes/authors, and the thickness of the lines indicates the strength of the connection between countries/institutes/authors.\u003c/p\u003e\n\u003cp\u003e(D) Three-field plot among countries, authors, and affiliations (left field: authors, middle field: countries, right field: affiliations; number of items each column: 20).\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7244813/v1/3d36a67f7f88c8b61c814a18.jpg"},{"id":88644604,"identity":"bdc45fd7-2d33-4050-9759-e6be1ee3b972","added_by":"auto","created_at":"2025-08-08 16:20:32","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":951395,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnalysis of journals and co-cited journals.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Analysis of journals published. The node size represents the number of articles published in the journal, and the node color represents the average time of articles published in the journal.\u003c/p\u003e\n\u003cp\u003e(B) Journal co-citation analysis. Node colors represent different domains.\u003c/p\u003e\n\u003cp\u003e(C) Dual map overlay of journals.\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7244813/v1/1d7a35ecaa6fa08d01654249.jpg"},{"id":88644613,"identity":"205c98dc-e657-489e-8f65-f9686d243ead","added_by":"auto","created_at":"2025-08-08 16:20:32","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":904546,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAnalysis of most commonly cited references.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Visualization of co-cited references. The node size corresponds to the citation count of the references, while the color intensity indicates the publication year. Nodes with a purple hue signify high centrality, marking them as pivotal nodes.\u003c/p\u003e\n\u003cp\u003e(B) Cluster analysis of co-cited references.\u003c/p\u003e\n\u003cp\u003e(C) Timeline graph of cluster analysis.\u003c/p\u003e\n\u003cp\u003e(D) Top 25 references with the strongest bursts. The red line segment represents the time when the references emerge. The larger the strength value, the larger its burst strength section.\u003c/p\u003e","description":"","filename":"Figure5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7244813/v1/979e22516602af76688fd63f.jpg"},{"id":88645723,"identity":"5f1551c5-7867-4359-b197-53991cf2feff","added_by":"auto","created_at":"2025-08-08 16:28:32","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":895407,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKeywords visual analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Visual analysis of keyword frequency. Node size represents the frequency of keyword occurrence, and color represents the average time of occurrence of the keyword.\u003c/p\u003e\n\u003cp\u003e(B) Keyword density stacking. Higher brightness indicates greater connection of the keyword.\u003c/p\u003e\n\u003cp\u003e(C) Timeline map of keyword co-occurrence.\u003c/p\u003e\n\u003cp\u003e(D) Top 11 keywords with the strongest bursts. The red line segment represents the time when the keyword emerges. The larger the strength value, the larger its burst strength section.\u003c/p\u003e","description":"","filename":"Figure6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7244813/v1/c73cc96297900181d9383fd7.jpg"},{"id":95527666,"identity":"a52faf35-a09c-4875-8d00-b4d7a5bb5231","added_by":"auto","created_at":"2025-11-10 10:14:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5997051,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7244813/v1/3d748293-cead-4573-8ece-ef3063c55426.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unveiling the Landscape of Vancomycin in Periprosthetic Joint Infections: A Comprehensive Bibliometric Analysis","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePeriprosthetic joint infection (PJI) refers to an infection occurring at the site of an artificial joint implant, affecting both the prosthetic joint and the adjacent tissues[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. It is considered one of the most devastating complications following total joint arthroplasty, significantly affecting patient morbidity, healthcare costs, and long-term outcomes. The incidence of PJI is about 1% after total hip arthroplasty (THA) and 1\u0026ndash;2% after total knee arthroplasty (TKA)[16; 36]. Furthermore, PJI is responsible for 14.8% of revision cases in hip joints and 25.2% in knee joints[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Its rising incidence is linked to increasing obesity, diabetes, and other comorbidities, as well as the growing number of arthroplasties performed[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. PJI negatively impacts quality of life, leads to longer hospital stays, extended antibiotic treatments, and multiple surgeries, creating significant health and economic challenges[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Managing prosthetic joint infections (PJI) typically requires surgery and antimicrobial therapy to eliminate the infection while maintaining joint function[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Nevertheless, the rising prevalence of antimicrobial resistance and the formation of microbial biofilms on prosthetic surfaces present substantial challenges to effective treatment.\u003c/p\u003e\u003cp\u003eVancomycin, a glycopeptide antibiotic discovered in the 1950s, is vital for treating severe Gram-positive infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (CoNS), due to its unique ability to inhibit cell wall synthesis by binding to peptidoglycan precursors[3; 62]. In the context of periprosthetic joint infection, coagulase-negative Staphylococcus species, particularly Staphylococcus epidermidis, are the most commonly identified pathogens, responsible for approximately 37% of cases, followed by Staphylococcus aureus and Cutibacterium acnes[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Vancomycin is crucial for treating these infections due to its broad-spectrum efficacy and ability to penetrate bone and joint tissues. It is used in various treatment methods, such as systemic administration and antibiotic-loaded bone cement spacers, achieving over 85% success in initial two-stage revision procedures when combined with other antibiotics like Ceftazidime[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Despite its critical role in PJI management, vancomycin faces challenges like toxicity, resistance, and limited effectiveness against biofilms and culture-negative infections. Systemic use can cause nephrotoxicity, with up to 32% incidence in continuous intravenous infusions[\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]. Its efficacy is notably reduced against biofilm-encased bacteria, with biofilm-associated MRSA showing up to 1,000 times more resistance than planktonic cells[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Consequently, research is needed to tackle resistance, optimize dosing, and improve delivery methods for better PJI management.\u003c/p\u003e\u003cp\u003eBibliometric analysis uses statistical methods to explore relationships between published articles and their data, offering insights into the intellectual structure and evolution of research fields[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. It is essential for identifying trends, fostering collaboration, and guiding future research. The study conducted by Ma et al. utilized a meta-analysis in conjunction with bibliometric analysis to ascertain the incidence of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) and to explore the prevailing issues associated with TKA-related PJI [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Similarly, Pei et al. employed bibliometric analysis to examine the current status, developmental trends, and primary focus areas in prosthetic joint infection research from 2013 to 2023[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. To our knowledge, no bibliometric analysis has been done on vancomycin use in periprosthetic joint infections. This study aims to quantitatively analyze related publications, identify key contributors, assess the research landscape, and highlight major scientific challenges. The findings are expected to provide valuable insights for clinicians and researchers, promoting further investigation.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Data sources and search strategy\u003c/h2\u003e\u003cp\u003eIn this study, data pertaining to the application of vancomycin in periprosthetic joint infection were extracted from the Science Citation Index Expanded (SCI-E) within the Web of Science Core Collection (WoSCC). Recognized as one of the most authoritative and influential databases, WoSCC encompasses 18,000 journals across 256 disciplinary categories and is frequently utilized in bibliometric analyses due to its comprehensive information[6; 38]. The literature search was conducted on July 6, 2025, employing a search strategy focused on topics related to vancomycin and periprosthetic joint infection. The specified search strategy was TS = (\"Periprosthetic joint infection\" OR \"Prosthetic joint infection\") AND TS = (Vancomycin).\u003c/p\u003e\u003cp\u003eTo ensure data accuracy, the literature search was completed within a single day. The study's temporal scope spans 15 years, from January 1, 2010, to July 6, 2025. The document types were restricted to research articles and reviews, and the publication language was limited to English. The literature search process was independently conducted by two researchers to ensure reliability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Data selection and extraction\u003c/h2\u003e\u003cp\u003eThe two researchers critically assessed the inclusion criteria within the context of uncertainties surrounding the relevance of vancomycin application in periprosthetic joint infections. Following the exclusion of duplicates, irrelevant literature, documents with incomplete information\u0026mdash;such as those lacking essential keywords that impeded analysis\u0026mdash;as well as retractions, errata, conference papers, patents, newspapers, and non-research outputs, a total of 451 documents were selected. The comprehensive search process is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eThe raw data file formats were extracted from the Web of Science Core Collection for subsequent analysis. The following data were extracted from the selected publications: title, year of publication, author, country/region, institution, journal (including the journal impact factor for 2024), H-index, references, and keywords. Upon obtaining the data, we manually eliminated duplicate authors and corrected misspelled elements.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data analysis\u003c/h2\u003e\u003cp\u003eBibliometrix version 4.3.0 (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.bibliometrix.org\u003c/span\u003e\u003cspan address=\"https://www.bibliometrix.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), an R package that provides functions for quantitative research in bibliometrics and scientometrics, was utilized in this study[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Specifically, the Bibliometrix R package was employed to automate the transformation and analysis of bibliographic information for the selected publications.\u003c/p\u003e\u003cp\u003eGraphPad Prism version 10.1.2 (GraphPad Inc, San Diego, CA, USA) was employed for the generation of graphical representations. This included line charts depicting the annual number of publications, citation counts, and H-index, as well as bar charts illustrating the cumulative number of publications per year.\u003c/p\u003e\u003cp\u003eVOSviewer, a prominent scientometric network analysis tool developed by the Center for Science and Technology Research, is extensively utilized for organizing and visualizing bibliometric data[\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e]. In this study, VOSviewer (version 1.6.20) was utilized to generate visual graphs and to analyze collaborations among countries/regions, institutions, and authors, as well as to identify the most co-cited journals and frequently co-occurring keywords.\u003c/p\u003e\u003cp\u003eCiteSpace, a Java-based application developed by Professor Chaomei Chen, serves as another visualization instrument for bibliometric and comparative analysis[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this research, CiteSpace (version 6.4.R1) facilitated visual analysis of the knowledge domain and emerging trends through cluster analysis, dual-map overlay, timeline view, and detection of citation bursts in keywords and references.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Study selection\u003c/h2\u003e\u003cp\u003eAs depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, an initial search of the WoSCC database on vancomycin in prosthetic joint infections found 582 records, with no duplicates or irrelevant entries. After excluding 16 records outside the 2010\u0026ndash;2025 timeframe and 5 non-English records, the focus was narrowed to research articles and reviews, eliminating 10 more records. This left 451 publications for final analysis.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Annual quantitative distribution and characteristics of publications\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eA shows a rise in publications on vancomycin in periprosthetic joint infections, with a steady increase from 2010 to 2019, a slight dip until 2021, and then a consistent rise, peaking at 63 publications in 2024, or 13.97% of the total. In the first half of 2025, publications have already exceeded half of 2024's total. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eB shows a steady rise in publications from 2010 to 2025. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003eC highlights that from 2010 to 2022, articles averaged over two citations annually, and the H-index increased from 3 in 2010 to 24 in 2019, indicating growing interest in vancomycin's role in treating periprosthetic joint infections.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Distribution and cooperation of countries/regions\u003c/h2\u003e\u003cp\u003e\u003cp\u003eFrom 2010 to 2025, 43 countries contributed to this research. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e lists the top 12 contributors, with the U.S. leading at 176 publications (39.2%), followed by China with 83 (18.4%), and Germany with 46 (10.2%). The U.S. also leads in citations with 4,755, followed by China with 1,227, and Germany with 1,144. Additionally, the H-index rankings are topped by the United States (36), followed by China (20) and Italy (14), highlighting the U.S.'s leading role in vancomycin research for prosthetic joint infections. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eA shows a co-authorship network map, with countries grouped into four clusters by collaboration level. The USA has the strongest international network, notably with China, Germany, and England. Germany also collaborates closely with England and Switzerland.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe top 12 most productive countries regarding vancomycin in periprosthetic joint infection research from 2010 to 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCounts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal citations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eH-Index\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGermany\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e674\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e813\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEngland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e779\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAustria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCanada\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e360\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSwitzerland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e981\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAustralia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eItaly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJapan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe top 10 most productive institutions regarding vancomycin in periprosthetic joint infection research from 2010 to 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInstitution\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCounts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal citations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eH-Index\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMayo Clinic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e724\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eXinjiang Medical University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e251\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRothman Institute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e756\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThomas Jefferson University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e730\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity Of California System\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInstitut National De La Sante Et De La Recherche Medicale Inserm\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChang Gung Memorial Hospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eChina\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e352\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity System Of Ohio\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e531\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOhio State University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHosp Special Surg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e291\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Distribution and cooperation of institution\u003c/h2\u003e\u003cp\u003eFrom 2010 to 2025, 725 institutions researched vancomycin in periprosthetic joint infections. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e highlights the top 10 institutions by publication volume, with the Mayo Clinic leading at 28 publications (6.21%), followed by Xinjiang Medical University with 19 (4.21%), and both the Rothman Institute and Thomas Jefferson University with 18 each (3.99%). The Rothman Institute, Thomas Jefferson University, and Mayo Clinic also topped the citation list with 756, 730, and 724 citations respectively, all sharing the highest H-index of 13. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eB shows a co-authorship network map of 51 institutions with more than three publications, featuring 352 collaborations across six clusters, each marked by different colors. The Mayo Clinic in the USA has the strongest international collaboration network, while the University of Southampton and Rush University also show significant partnerships in this research field.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.5. Distribution and cooperation of authors of publications\u003c/h2\u003e\u003cp\u003e\u003cp\u003eFrom 2010 to 2025, 2,425 authors have contributed to vancomycin research in periprosthetic joint infection. According to Price\u0026rsquo;s Law, the core group of authors, those with four or more publications, includes 28 individuals. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e lists the top 10 authors by publication count, with Cao L leading at 18 (3.99%), followed by Parvizi J with 13 (2.88%), and Patel R with 11 (2.44%). Parvizi J has the most citations at 613, followed by Tan Tl with 288, Cao L with 249, and Patel R with 205. Cao L also has the highest H-index (9), G-index (15), and M-index (1), indicating a significant impact in this research area. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eC shows a co-authorship network for authors with over two publications, involving 103 institutions and 816 collaborations, divided into six color-coded clusters. Patel R has the broadest international network, while Cao L and Parvizi J also have strong collaborations. Figure\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eD displays a three-field plot linking countries, authors, and affiliations. The United States leads in connections with authors (12/20) and affiliations (10/20), followed by China (authors\u0026thinsp;=\u0026thinsp;10/20, affiliations\u0026thinsp;=\u0026thinsp;7/20). Patel R and Parvizi J are connected to China, whereas Cao L, Mu Wb, Wang Y, and Tan Tl are linked to the United States.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe top 10 most productive authors regarding vancomycin in periprosthetic joint infection research from 2010 to 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAuthor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCounts\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal citations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eH-Index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eG-Index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eM-Index\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCao L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParvizi J\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e613\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.643\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatel R\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.438\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStoodley P\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEsteban J\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.538\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFerry T\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchwarzkopf R\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTan Tl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eZhang X\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.857\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWang Y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e193\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.455\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.6. Analysis of source journals and co-cited journals\u003c/h2\u003e\u003cp\u003eBetween 2010 and 2025, 451 references on vancomycin in prosthetic joint infections were published in 148 journals. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e lists the top 12 journals by publication count, impact factors (IF), and JCR quartiles. The Journal of Arthroplasty led with 64 publications (14.9%) and 1,521 citations, followed by Antibiotics-Basel with 31 publications (6.87%), and the Bone \u0026amp; Joint Journal with 18 publications (3.99%). Clinical Orthopaedics and Related Research had the highest average citations per paper. Nine of the top 12 journals were in the Q1 JCR division, and eight had an impact factor over three. Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA shows the connections among journals in vancomycin PJI research. Antibiotics-Basel leads in publication output over the past three years. The journals are divided into four co-citation clusters: red for joints and orthopedics, yellow for clinical bone and joint health, green for biomaterials and microbiology, and blue for microbial infection and treatment. A dual map overlay of the journals was used to visually analyze topic distribution, citation trends, and research center shifts. Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC shows green paths indicating that journals in molecular biology, genetics, healthcare, and nursing medicine are frequently cited by those in the medicine and clinical fields, with some cross-disciplinary citations.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe top 12 most productive journals regarding vancomycin in periprosthetic joint infection research from 2010 to 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJournal title\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRecords\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003ecitations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003cp\u003ecitation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eH-Index\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIF\u003c/p\u003e\u003cp\u003e(2024)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eJCR\u003c/p\u003e\u003cp\u003e(2024)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJournal Of Arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1521\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAntibiotics-Basel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBone \u0026amp; Joint Journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e510\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBone \u0026amp; Joint Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e286\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e17.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e5.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical Orthopaedics And Related Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e59.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAntimicrobial Agents And Chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e702\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e50.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJournal Of Orthopaedic Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e491\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e44.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJournal Of Orthopaedic Surgery And Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBmc Infectious Diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJournal Of Bone And Joint Surgery-American Volume\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e33.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHip International\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJournal Of Clinical Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eQ1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Analysis of highly cited studies\u003c/h2\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e ranks the top 10 most cited studies among 451 publications analyzed, all with over 100 citations and published between 2011 and 2022. Over half are from the United States, including two from the University of Rochester. The most cited study, \"Skeletal Infections: Microbial Pathogenesis, Immunity, and Clinical Management[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e],\" published in 2022 by University of Rochester researchers in Nature Reviews Microbiology, received 374 citations.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTop 10 cited publications regarding vancomycin in periprosthetic joint infection research from 2010 to 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFirst author\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInstitution\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003cp\u003ecitations\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAverage\u003c/p\u003e\u003cp\u003ecitation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSkeletal infections: microbial pathogenesis, immunity and clinical management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNature Reviews Microbiology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMasters, Elysia A.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity of Rochester, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e93.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo-stage Treatment of Hip\u0026nbsp;Periprosthetic Joint Infection\u0026nbsp;Is Associated With a High Rate of Infection Control but High Mortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Orthopaedics And Related Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBerend, Keith R.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eJIS Orthoped Inc, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e299\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e23.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal Of Orthopaedic Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSchwarz, Edward M.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity of Rochester, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e29.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePropionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBiomed Research International\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePortillo, Maria Eugenia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCentrode Investigacion Biomedica enRed, Spain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e15.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMicrobiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAntimicrobial Agents And Chemotherapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeel, Trisha\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMonash University, Australia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e198\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMortality During Total Hip\u0026nbsp;Periprosthetic Joint Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal Of Arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNatsuhara, Kyle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity of California, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e23.00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2019 John Charnley Award: Increased risk of\u0026nbsp;prosthetic joint infection\u0026nbsp;following primary total knee and hip arthroplasty with the use of alternative antibiotics to cefazolin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBone \u0026amp; Joint Journal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWyles, Cody C.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMayo Clinic, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e17.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eApproach to Septic Arthritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAmerican Family Physician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHorowitz, Diane\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNorthwell, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e7.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvidence-Based Recommendations for Local Antimicrobial Strategies and Dead Space Management in Fracture-Related Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal Of Orthopaedic Trauma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMetsemakers, Willem-Jan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity Hospital Leuven, Belgium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e18.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMicrobiologic epidemiology depending on time to occurrence of\u0026nbsp;prosthetic joint infection: a prospective cohort study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Microbiology And Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTriffault-Fillit, Claire\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCHU Lyon, France\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.8 Analysis of co-cited references\u003c/h2\u003e\u003cp\u003e\u003cp\u003eA co-citation analysis was performed to explore the interconnections within the literature and highlight the evolving scientific landscape. The study found 10,192 co-cited references related to vancomycin use in prosthetic joint infections. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e lists the top 10 highly co-cited references, published between 2004 and 2018, with eight from the U.S. and two from Switzerland and Spain. The most cited work was \"Diagnosis and Management of Prosthetic Joint Infection\" by Osmon Douglas R (2013) with 88 citations, followed by Zimmerli W's \"Current Concepts: Prosthetic-Joint Infections\" (2004) with 85 citations, and Kurtz Steven M's \"Economic Burden of Periprosthetic Joint Infection in the United States\" (2012) with 75 citations. Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eA shows a network of co-cited references, highlighting \"Osmon DR (2013),\" \"Heckmann ND (2019),\" and \"Kheir MM (2015)\" as frequently co-cited in vancomycin and prosthetic joint infection research. Cluster analysis, with a Q value of 0.8148 and S value of 0.9193, identified 13 significant clusters, five of which are prominent: \u0026ldquo;intrawound vancomycin,\u0026rdquo; \u0026ldquo;orthopedic infection,\u0026rdquo; \u0026ldquo;rat model,\u0026rdquo; \u0026ldquo;high-dose antibiotic-loaded bone cement,\u0026rdquo; and \u0026ldquo;antibiotic resistance.\u0026rdquo; Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eC shows a timeline of distinct research clusters, highlighting the emerging cluster of \"intrawound vancomycin,\" \"rat model,\" and \"radiation crosslinking\" as current research frontiers. Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003eD lists the top 25 references with significant citation bursts from 2010 to 2025, with Osmon DR's 2013 study having the highest burst strength of 12.95. This study offers recommendations for diagnosing and managing periprosthetic joint infection[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Recent contributions by Premkumar A, Dagneaux L, Park KJ, Parkinson B, Buchalter DB, and Feder OI have spurred increased research interest in vancomycin's role in periprosthetic joint infection.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe top 10 co-cited references for vancomycin in periprosthetic joint infection research from 2010 to 2025\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTitle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFirst author\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eInstitution\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCitations\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Infectious Diseases\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOsmon, Douglas R.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMayo Clinic, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCurrent concepts: Prosthetic-joint infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNew England Journal Of Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZimmerli, W\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity of Basel, Switzerland\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEconomic burden of periprosthetic joint infection in the United States\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal Of Arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKurtz, Steven M.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDrexel University, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProsthetic Joint Infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Microbiology Reviews\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTande, Aaron J.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMayo Clinic, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProjections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal Of Bone And Joint Surgery-American Volume\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKurtz, Steven\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDrexel University, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThe 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal Of Arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eParvizi, Javad\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThomas Jefferson University, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriprosthetic joint infection: The incidence, timing, and predisposing factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Orthopaedics And Related Research\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePulido, Luis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eThomas Jefferson University, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeriprosthetic joint infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLancet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKapadia, Bhaveen H.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSUNY Downstate Health Sciences University, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfection Associated with Prosthetic Joints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNew England Journal Of Medicine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDel Pozo, Jose L.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity of Navarra, Spain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInfection burden for hip and knee arthroplasty in the United States\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eJournal Of Arthroplasty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eKurtz, Steven M.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDrexel University, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.9 Analysis of keywords\u003c/h2\u003e\u003cp\u003eKeywords are often used in references to summarize research themes, and analyzing their co-occurrence helps identify key areas and future research directions. Figures\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA and \u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eB show the network and density maps of co-occurring keywords. The top ten keywords are vancomycin, \"periprosthetic joint infection,\" \"prosthetic joint infection,\" hip, arthroplasty, \"total knee arthroplasty,\" revision, antibiotics, biofilm, and debridement. Keywords appearing more than five times were grouped into five clusters, each with a unique color representing different research directions (see Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA). The largest cluster, in red, includes 40 keywords like \"vancomycin,\" \"prosthetic joint infection,\" \"antibiotics,\" \"biofilm,\" and \"osteomyelitis.\" Cluster 2, in green, has 38 keywords, including \"revision,\" \"debridement,\" \"management,\" \"2-stage revision,\" and \"total hip arthroplasty.\" Cluster 3 (blue) featured 37 keywords, including \"periprosthetic joint infection\" and \"total knee arthroplasty.\" Cluster 4 (yellow) had 30 keywords like \"gentamicin\" and \"staphylococcus aureus elution.\" Cluster 5 (purple) comprised 28 keywords such as \"hip\" and \"arthroplasty.\" Keyword density maps illustrated these terms (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eB), while CiteSpace showed their evolution over time (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eC), with a Q-value of 0.3767 and an S-value of 0.6926. A total of 10 research clusters were identified, covering topics like \"prosthetic joint infection,\" \"knee arthroplasty,\" and \"acute kidney injury.\" Recently, \"knee arthroplasty\" and \"prosthetic joint infection\" have been key research areas. Identifying burst keywords helps track research trends and predict future breakthroughs. Figure\u0026nbsp;7D shows the top 10 keywords with significant citation bursts, with \"bone cement\" leading at 4.98, followed by \"tobramycin\" at 4.60 and \"daptomycin\" at 4.11. \"Implant retention\" and \"higher tissue concentrations\" have recently become research focal points.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Disscussion","content":"\u003cp\u003eIn this study, we conducted a bibliometric and visual analysis to objectively interpret the literature concerning the application of vancomycin in periprosthetic joint infection. A total of 451 publications were identified in this field from 2010 to 2025, comprising 407 articles and 44 reviews. Our findings indicate a significant upward trend in the number of annual publications, with notable peaks in 2019 and 2024. The increasing trend indicates that the application of vancomycin in the context of periprosthetic joint infections has garnered heightened attention in recent years. Notably, 2019 marked a pivotal year in this domain, as it witnessed the first peak in citation counts and the highest observed H-index. The subsequent decline in citations and H-index over the past four years may be attributed to the temporal proximity of the data collection period.\u003c/p\u003e\u003cp\u003eThe volume of publications, citations, and H-index within a specific research field are recognized as critical indicators for evaluating the academic reputation and scientific research capabilities of a country or institution[\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e]. In this analysis, the United States emerged not only as the nation with the highest number of publications but also as the leader in citation counts and H-index. Furthermore, the United States demonstrated extensive international collaborative relationships with countries such as China, Germany, and the United Kingdom. These findings suggest that the United States plays a dominant role in advancing research in this area and may significantly influence its future trajectory. Regarding institutional contributions, while the Mayo Clinic and Xinjiang Medical University ranked first and second, respectively, in terms of the number of published papers, they did not demonstrate a significant advantage in citations and H-index. Except for the Mayo Clinic, collaboration among other institutions with high publication output was not sufficiently robust, highlighting the need for increased international multicenter cooperation to enhance the dissemination and academic impact of research findings.\u003c/p\u003e\u003cp\u003eCo-authorship analysis can assist researchers in understanding the relationships between researchers in a specific area and identifying potential collaborations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Among authors, Cao L distinguished themselves by having the highest number of publications, while Parvizi J was notable for achieving the highest number of citations, each excelling in their respective domains. Furthermore, Cao L and Parvizi J maintained a strong collaborative relationship within this research field. Their joint work revealed that higher preoperative synovial white blood cell counts were associated with successful outcomes in single-stage exchange arthroplasty or debridement, combined with antibiotics and implant retention with topical antibiotic infusion for PJI[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Furthermore, recent research has demonstrated that intraoperative sonication can effectively enhance culture yield and reduce the time to positivity in patients with periprosthetic joint infections (PJI), thereby facilitating targeted antibiotic therapy to improve treatment outcomes and promote antibiotic stewardship[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Patel R. is noted as the author with the most international collaborations in this field, with a primary focus on the pathogens, antibiotic drugs, and genomic studies associated with periprosthetic joint infections[12; 25; 67].\u003c/p\u003e\u003cp\u003eThe evaluation of scholarly journals aids authors in selecting the most appropriate platform for publishing their research findings and provides researchers with suitable channels to stay informed about the latest advancements in a specific field. Generally, the influence of a journal is closely related to the impact of its articles, and the impact factor serves as an indicator to assess a journal's influence by measuring its citation rate, academic rigor, and the quality of its publications[41; 79]. The majority of high-output journals are classified as Q1, indicating that research conducted in this field holds significant scholarly value and is widely recognized. The Journal of Arthroplasty, Clinical Orthopaedics and Related Research, and Bone \u0026amp; Joint Research are recognized as the most influential journals in the domain of vancomycin application for periprosthetic joint infection. Among these, the Journal of Arthroplasty boasts the highest number of publications and the greatest H-index. Clinical Orthopaedics and Related Research leads in average citations per paper, while Bone \u0026amp; Joint Research possesses the highest impact factor among high-output journals. These journals provide scholars with enhanced access to cutting-edge research and facilitate the dissemination of their findings in this area. Notably, the Journal of Arthroplasty remains the preeminent academic journal in this field, as evidenced by journal clustering and co-citation analyses. This underscores its significant academic influence and its potential as a platform for advancing future research on vancomycin in PJI.\u003c/p\u003e\u003cp\u003eHighly cited references are typically considered the most significant and influential contributions within a field. Among the top ten cited publications, the most highly cited work systematically investigated and summarized microbial pathogenesis, immunity, and clinical management in skeletal infections[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Berend et al. identified that the two-stage treatment for deep infections is associated with a significant mortality rate and a notable failure rate due to reinfection and the inability to proceed to the second stage of treatment in both primary and revision total hip arthroplasty[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Schwarz et al. discussed research priorities related to musculoskeletal infections, including distinctions between acute and chronic infections, host immunity, antibiotics, diagnosis, research limitations, and modifiable factors, during the 2018 International Consensus Meeting on Musculoskeletal Infection[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The study by Portillo et al. primarily reviewed the pathogenic role of Propionibacterium acnes in implant-associated infections, including those involving artificial joints[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Peel et al. conducted a study on the epidemiology and microbiological etiology of periprosthetic joint infection (PJI), revealing that in 63% of PJI cases, the microorganisms identified were resistant to the prophylactic antibiotics administered[\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]. This finding suggests a diverse array of pathogens involved in the infection process. Natsuhara et al. reported a notably high mortality rate associated with total hip PJI, with a five-year mortality rate of 21.12%[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This highlights the critical need to address mortality risks when counseling patients who develop this complication. Wyles et al. demonstrated a 32% reduction in the risk of PJI when cefazolin was used for perioperative infection prevention, emphasizing the beneficial role of preoperative antibiotic allergy testing in increasing cefazolin utilization[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Horowitz et al. reviewed treatment strategies for septic arthritis, recommending vancomycin for Gram-positive cocci[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In cases where the Gram stain was negative but clinical suspicion of bacterial arthritis remained high, they suggested a combination of vancomycin with ceftazidime or aminoglycosides. Metsemakers et al. concentrated on elucidating the existing local antimicrobial strategies employed in the management of fracture-related infections, paralleling the extensive research conducted on local antimicrobial therapy for periprosthetic joint infections[\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. A prospective cohort study by Triffault-Fillit et al. indicated that the combination of vancomycin with broad-spectrum β-lactam antibiotics may be effective only in patients with late periprosthetic joint infections (defined as prosthesis implantation for more than 12 months)[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This finding suggests that the empirical use of broad-spectrum β-lactam antibiotics should be reevaluated in cases of late periprosthetic joint infections. Analyzing these highly cited articles offers perspectives and insights into the most influential contributions within the research domain of vancomycin in periprosthetic joint infections.\u003c/p\u003e\u003cp\u003eThrough co-citation reference analysis, the underlying trends in research literature categories over a specific period can be uncovered, with studies possessing high co-citation rankings often regarded as foundational research in the field[\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. Presented below are the top 10 co-cited references for research on vancomycin and prosthetic joint infections from 2010 to 2025. Osmon DR et al., as the most frequently co-cited reference from the Mayo Clinic, authored the clinical practice guidelines of the Infectious Diseases Society of America. These guidelines propose diagnostic and management strategies for periprosthetic joint infections and are intended for use by infectious disease specialists, orthopedic surgeons, and other healthcare professionals involved in patient care[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Another study conducted at the Mayo Clinic by Tande AJ et al. examined the reported risk factors and clinical manifestations of PJI, discussed its pathogenesis and the various microorganisms responsible for this severe infection, and outlined strategies for its treatment and prevention[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Kurtz SM et al. from Drexel University contributed three high-quality studies that primarily focused on the burden of hip and knee arthroplasty and periprosthetic joint infections[\u003cspan additionalcitationids=\"CR65\" citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. Their 2007 research projected a 137% increase in total hip revision surgeries and a 601% increase in total knee revision surgeries between 2005 and 2030, providing a quantitative foundation for future policy decisions to address this rising demand. In 2008, research indicated that the infection rate for knee arthroplasty was 0.92%, which was notably higher than the 0.88% infection rate for hip arthroplasty. Additionally, there was an observed increase in the diagnosis of joint replacement surgeries as periprosthetic infections. A subsequent study conducted in 2012 examined the patient and clinical factors influencing the economic impact of periprosthetic joint infections in the United States. This study projected that the economic burden of prosthetic infections would significantly escalate due to the anticipated rise in demand for joint replacement surgeries over the following decade. Two studies from Thomas Jefferson University concentrated on the incidence, timing, risk factors, and diagnostic criteria associated with periprosthetic joint infections[31; 43]. A study from 2008 reported a periprosthetic joint infection rate of 0.7%, with 65% of infections occurring within the first year after joint replacement. Independent predictive factors for these infections included a higher American Society of Anesthesiologists score, morbid obesity, bilateral arthroplasty, knee arthroplasty, allogenic transfusion, postoperative atrial fibrillation, myocardial infarction, urinary tract infection, and prolonged hospitalization. In 2018, the institution's research advanced the diagnostic criteria for periprosthetic joint infections, achieving an enhanced sensitivity of 97.7% while maintaining a specificity of 99.5%, comparable to the benchmarks established by the International Consensus Meeting. Concurrently, research from other institutions has contributed significantly to this domain. Zimmerli et al. noted that despite advancements in technology reducing the incidence of periprosthetic joint infections (PJI), these infections continue to present substantial challenges in clinical management[\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. They provided a comprehensive summary of guidelines for accurate diagnosis and proposed an algorithm that includes appropriate medical and surgical interventions. Furthermore, a review by Kapadia BH et al. assessed the risk factors, preventive strategies, diagnostic approaches, clinical manifestations, and treatment modalities for prosthetic joint infections, indicating that the field of orthopedics could greatly benefit from improved methods in prevention, diagnosis, and treatment[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Del Pozo et al. highlighted that, based on current treatment protocols for periprosthetic joint infection following total hip arthroplasty, a two-stage exchange arthroplasty in conjunction with a four-week antibiotic therapy is a more appropriate choice[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. These studies offer a comprehensive overview of the existing knowledge regarding the use of vancomycin in the treatment of periprosthetic joint infections, significantly contributing to the advancement of fundamental research in this domain.\u003c/p\u003e\u003cp\u003e\u003cp\u003eEmerging academic centers can be identified through the analysis of co-citation clusters, which reflect the core content and emerging topics within specific fields[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Cluster #0, labeled \"intrawound vancomycin,\" was not only the largest cluster but also among the most recent in terms of temporal development within this field. Hanada M et al. examined the efficacy and adverse effects of high-dose topical vancomycin powder in preventing periprosthetic joint infections (PJI) in total knee arthroplasty and unicompartmental knee arthroplasty[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Their findings indicated that the intrawound application of vancomycin powder did not decrease the incidence of PJI and was significantly associated with aseptic wound complications. Consequently, the use of intrawound vancomycin powder for PJI prevention in primary total knee arthroplasty and unicompartmental knee arthroplasty is not recommended. Another noteworthy and relatively recent research cluster in this field is Cluster #2. Ji B et al. conducted a comparative study to evaluate the efficacy of one-stage revision surgery in patients with culture-negative periprosthetic joint infection (PJI), treated with intravenous vancomycin and alternating intra-articular injections of vancomycin and imipenem, versus those with culture-positive PJI, treated with pathogen-sensitive intravenous antibiotics[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The findings indicated that one-stage revision surgery, supplemented with direct intra-articular antibiotic administration, is effective in managing culture-negative PJI, achieving infection control rates comparable to those observed in culture-positive cases. Further investigation revealed that intra-articular administration of antibiotics such as vancomycin and imipenem during one-stage revision can result in high antibiotic concentrations in the synovial fluid, thereby addressing challenges related to compromised vascular supply and biofilm formation[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This alternative route of administration may represent a viable strategy for managing reinfected PJI following multiple previous surgical failures. In the recently identified #9 cluster, Corona PS et al. conducted an investigation into the outcomes of two-stage revision in patients with periprosthetic joint infection who were not considered for reimplantation[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Their findings indicated that excluding patients who did not undergo reimplantation resulted in a 9% overestimation of the success rate within this series, suggesting that the actual success rate of two-stage revision may be lower than previously reported. In newly published high-intensity burst studies, Premkumar A et al. examined the current burden of PJI in the United States, estimating that the total annual hospitalization costs associated with PJI could reach \u003cspan\u003e$\u003c/span\u003e1\u0026nbsp;billion by 2030[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Further analysis indicated that the increase in PJI costs was primarily due to the rising number of cases, underscoring the urgent need for effective prevention strategies to reduce the incidence of PJI following joint arthroplasty. In summary, based on co-citation and cluster analysis, there is a growing research focus on the use of vancomycin in periprosthetic joint infections. Notably, In recent years scholarly focus in this domain has primarily concentrated on the localized administration of vancomycin for the treatment of periprosthetic joint infections, the success rates of PJI revision surgeries, and the relationship with the treatment burden of PJI. This trend signifies the emergence of novel academic interests.\u003c/p\u003e\u003cp\u003eAn analysis of keywords has highlighted current research hotspots and frontiers within the field of vancomycin use in PJIs. The analysis revealed that the most frequently occurring keywords pertained to the application strategies of vancomycin and the eradication of biofilms in revision surgeries for periprosthetic infections of the hip or knee. These findings align with the results from analyses of highly cited literature, suggesting these are the most extensively researched subfields. The synthesis of keyword clustering information facilitated a precise delineation of the research focus and scope within the field[\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e]. Timeline analysis indicated that clusters such as #0 prosthetic joint infection, #1 knee arthroplasty, and #5 Staphylococcus epidermidis have persisted to the present. his analysis suggests that research on periprosthetic joint infections associated with Staphylococcus epidermidis following knee arthroplasty not only constitutes a foundational study in this domain but also holds promise for pioneering new research directions. Collectively, these research clusters illustrate a diverse array of potential investigative pathways, underscoring the complex nature of studies concerning the application of vancomycin in PJIs and the persistent necessity for innovative strategies to tackle this clinical issue. The burst analysis of keywords indicates that early research predominantly concentrated on diagnosis, antibiotic efficacy, and the use of bone cement in the context of vancomycin application in PJIs. Subsequently, the focus shifted towards the management of PJIs using spacers, as well as prevention and implant retention strategies. Presently, research is primarily centered on investigations related to achieving higher tissue concentrations of vancomycin. By examining these keywords, it becomes more feasible to systematically review the overarching developmental trends within the research field of vancomycin application in periprosthetic joint infection.\u003c/p\u003e\u003cp\u003eRecent advancements in the application of vancomycin for addressing periprosthetic joint infection have markedly improved the effectiveness of both prevention and treatment strategies in revision surgeries. Vancomycin continues to serve as a fundamental component in the management of PJI, primarily due to its robust efficacy against Gram-positive pathogens, including MRSA and CoNS, both of which are commonly associated with biofilm-related infections[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The application of vancomycin in PJI has undergone significant evolution, with recent progress emphasizing the optimization of its delivery methods, pharmacokinetics, and therapeutic efficacy to effectively counteract the challenges posed by biofilm formation and antibiotic resistance[32; 59]. The integration of vancomycin with bone cement and localized drug delivery systems has consistently been a central focus of innovation in this field, addressing the limitations inherent in systemic antibiotic therapy, such as inadequate bone penetration and systemic toxicity.\u003c/p\u003e\u003cp\u003eOne of the most significant advancements in the field has been the incorporation of vancomycin-loaded bone cement in two-stage revision surgeries. This technique involves the application of an antibiotic-impregnated cement spacer during the initial stage, which not only provides mechanical stability but also facilitates the delivery of high local concentrations of vancomycin to effectively eradicate residual infections[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Empirical evidence indicates that vancomycin, particularly when combined with other antibiotics such as tobramycin or gentamicin, markedly reduces infection recurrence rates and enhances joint function following revision procedures[9; 56; 69]. Another innovative approach involves the localized administration of vancomycin, which ensures elevated concentrations at the infection site while minimizing systemic exposure and the risk of associated adverse effects. The study conducted by He JW et al. demonstrated that intra-articular infusion of vancomycin achieved sustained therapeutic concentrations in synovial fluid, which is crucial for the eradication of biofilm-embedded pathogens[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Their research indicated that an intra-articular injection of 0.5 g of vancomycin once daily, whether administered alone or in conjunction with intravenous administration, maintained effective trough concentrations in the synovial fluid, thereby improving therapeutic outcomes. A study indicated that a localized approach proved particularly beneficial in situations where systemic antibiotic therapy alone failed to adequately penetrate biofilms[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. Furthermore, the intraoperative application of vancomycin powder represented a notable advancement in research, particularly in procedures such as debridement, implant retention, and two-stage revision arthroplasty. This technique demonstrated efficacy in reducing the incidence of periprosthetic joint infection by delivering high local concentrations of vancomycin directly to the surgical site, thereby inhibiting bacterial colonization and biofilm formation[\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. Fabio et al. introduced the use of vancomycin powder in conjunction with diluted povidone-iodine irrigation to decrease the incidence of PJI in high-risk patients undergoing total knee arthroplasty[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Their findings revealed a reduction in PJI incidence by 44.6% and 56.4% in high-risk and overall risk cohorts, respectively, following early primary total knee arthroplasty. Additionally, the study by Shiyu L et al. examined the effects of topical application of varying doses of vancomycin powder on PJI incidence[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. The study identified that the application of 1g and 2g vancomycin powder during primary total knee arthroplasty was effective in preventing periprosthetic joint infection. In contrast, the use of 1g vancomycin powder was deemed more suitable for primary total hip arthroplasty, with the effectiveness of 2g vancomycin powder remaining uncertain[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Despite some evidence supporting the topical application of vancomycin powder in PJI prevention, the research findings are inconsistent and remain a subject of considerable debate[24; 54; 75].\u003c/p\u003e\u003cp\u003eThe novel drug delivery systems are being developed to enhance the localized release of vancomycin in PJI. Notably, carbon fiber-reinforced polyetheretherketone implants with a sustained-release mechanism of vancomycin have shown significant therapeutic efficacy in primary revision surgeries[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Additionally, vancomycin-loaded niosomes incorporated into fast-disintegrating oral films represent an innovative advancement in antibiotic delivery systems. These systems facilitate targeted delivery of vancomycin to infected sites, improving its bioavailability and therapeutic efficacy while reducing systemic side effects. Furthermore, microfluidic techniques are being utilized to prepare niosomes with optimal size and encapsulation efficiency[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The application of microfluidic techniques for the preparation of niosomes with optimal size and encapsulation efficiency has further enhanced the viability of this approach for both oral and systemic applications[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite vancomycin's critical role in the management of prosthetic joint infections (PJIs), its use is fraught with challenges, particularly in the face of increasing antimicrobial resistance and the intricate nature of these infections. A major limitation of vancomycin in the treatment of PJIs is its suboptimal pharmacokinetic and pharmacodynamic properties in bone and joint tissues. Achieving therapeutic concentrations at the site of infection is difficult due to poor penetration into biofilms and the avascular characteristics of prosthetic materials[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This necessitates the administration of higher doses, thereby elevating the risk of nephrotoxicity and other adverse effects, which complicates patient management[\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]. Furthermore, the empirical use of vancomycin, often commenced prior to pathogen identification, may result in inappropriate therapy and contribute to the development of resistance[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The absence of rapid diagnostic tools for the identification of causative pathogens and their resistance profiles further delays the initiation of targeted therapy[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Finally, the use of vancomycin bone cement may result in significant adverse reactions, including vancomycin flushing syndrome[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. In summary, recent advancements in the application of vancomycin for periprosthetic joint infections (PJI) have markedly enhanced its therapeutic efficacy, particularly through localized delivery systems, optimized pharmacokinetics, and innovative formulations. These developments have effectively addressed the challenges associated with biofilm-related infections and antibiotic resistance, thereby improving patient outcomes in PJI cases. Future research should concentrate on refining dosing regimens, investigating combination therapies, and identifying patient-specific factors that may influence treatment success, ultimately facilitating the development of more personalized and effective management strategies.\u003c/p\u003e\u003cp\u003eThis study offers a comprehensive bibliometric analysis of vancomycin in periprosthetic joint infection, but it has limitations. It relied solely on the WOSCC database, which may not capture all relevant literature, although it is recognized for high-quality analyses. Additionally, the focus on English-language publications from 2010 to 2025 excluded significant Chinese literature and contributions from Chinese researchers, potentially affecting the findings. Ongoing updates to the database may also lead to variations in bibliometric data, and discrepancies in author affiliations could introduce further inconsistencies. Lastly, discrepancies in author institutional affiliations may introduce inconsistencies.\u003c/p\u003e"},{"header":"5. Conlusion","content":"\u003cp\u003eThis study employed bibliometric analysis and visualization techniques to comprehensively delineate and assess the global landscape of research, development trends, prominent research avenues, and emerging focal points related to the application of vancomycin in periprosthetic joint infections. Despite minor fluctuations in the annual publication output within this research domain, an overall upward trend in scholarly activity was discernible. Notably, the United States emerged as the leading contributor to this field, with the Mayo Clinic producing the highest number of studies. However, Professor Cao Li from China distinguished himself by authoring the largest number of publications, thereby making substantial contributions to the discipline. The Journal of Arthroplasty was identified as the most influential academic journal in this area, underscoring its significant role in advancing the field. An analysis of keywords and co-cited references illuminated potential trends, current research hotspots, and frontiers within the domain of vancomycin application in periprosthetic joint infections. Emerging research focal points primarily centered on optimizing localized application methods and further development in this area. Emerging research has predominantly concentrated on advancing localized application techniques and developing innovative drug delivery systems to enhance therapeutic efficacy, particularly in overcoming the challenges associated with biofilm infections and antibiotic resistance. Additionally, the management of the burden in this domain has emerged as a significant research focus. In our study, we examined current research trends concerning the use of vancomycin in periprosthetic joint infections, highlighting the effectiveness of local applications (such as bone cement, intra-articular injections, or powder), the benefits of novel drug delivery systems, and the existing challenges. Our comprehensive review of the current knowledge landscape in this field provides researchers with essential insights, facilitating the identification of potential key research directions and enabling clinicians to deliver improved diagnostic and therapeutic services to patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eDeclaration of competing interest\u003c/h2\u003e\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eYuting Yang: Writing \u0026ndash; original draft, Visualization, Validation, Methodology, Formal analysis, Data curation. Ke Lv: Software, Visualization. Hongbo Li: Supervision, Visualization. Aidi Zhao: Visualization. Yong Ding: Writing \u0026ndash; review \u0026amp; editing, Funding acquisition, Conceptualization. Jinxue Zhang: Writing \u0026ndash; review \u0026amp; editing, Visualization, Software, Project administration, Methodology, Formal analysis, Data curation, Conceptualization.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAaron JT, Robin P (2014) Prosthetic joint infection. Clinical microbiology reviews\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAjay P, David AK, Kevin XF et al (2020) Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States. 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Front Endocrinol (Lausanne) 13:845776\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bibliometric analysis, Periprosthetic joint infection, Vancomycin, Biofilm, Antibiotic resistance.","lastPublishedDoi":"10.21203/rs.3.rs-7244813/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7244813/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction: Periprosthetic joint infection (PJI) is a\u003c/h2\u003e\u003cp\u003edevastating adverse complication after joint replacement surgery. Vancomycin is crucial in treating PJI but presents unique challenges. Despite extensive research, a comprehensive bibliometric analysis is missing. This study aims to identify key contributors, evaluate current research, and highlight major scientific issues.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe retrieved studies on vancomycin and PJI from the Web of Science Core Collection database, gathering data on publications, authors, citations, publication year, h-index, references, country/region, journal, and keywords. Bibliometric and visual analyses were conducted using R-bibliometrix, VOSviewer, and CiteSpace.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe analysis included 451 publications from 725 institutions in 43 countries/regions from 2010 to 2025, showing a clear growth trend in annual publications. The United States contributed the most (172, 39.2%), with the Mayo Clinic leading in studies (28, 6.21%). Cao L had the highest number of publications, while Parvizi J received the most citations. The Journal of Arthroplasty was the leading journal in this field. Current research on vancomycin in PJI focuses on improving localized application and new drug delivery systems to tackle biofilm infections and antibiotic resistance. Additionally, burden management has emerged as a significant research area.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study summarizes publications characteristics and identifies influential countries, institutions, authors, journals, and trends related to vancomycin use in PJI. The findings offer researchers valuable insights and help clinicians improve diagnostic and therapeutic services.\u003c/p\u003e","manuscriptTitle":"Unveiling the Landscape of Vancomycin in Periprosthetic Joint Infections: A Comprehensive Bibliometric Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 16:20:27","doi":"10.21203/rs.3.rs-7244813/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b749d70-7797-4a8c-9e04-f9b363e8254d","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-08T10:53:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 16:20:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7244813","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7244813","identity":"rs-7244813","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}