Delayed postbacteremic prosthetic joint infection.

Deep infection of a prosthetic joint is a devastating complication. One proposed mechanism of late prosthetic joint infection involves hematogenous spread from an extraarticular focus of infection. Two cases clearly demonstrate hematogenously acquired prosthetic joint infections, one caused by Clostridium perfringens and the other by Streptococcus pneumoniae. These cases were unusual in that a long asymptomatic period intervened between the primary bacteremic illness and the subsequent prosthetic infection. Patients with prosthetic joints who develop bacteremic infection at extraarticular sites should be treated promptly and aggressively with appropriate antibiotics. Prophylactic antibiotics should be strongly considered in the patient with a prosthetic joint who undergoes procedures likely to be associated with a bacteremia. Transient arthralgias at the time of bacteremia may represent the onset of the joint infection and should not be overlooked or attributed a priori to the patient's underlying arthritic or medical condition.