Hematogenous infection of total joint implants: a report of multiple joint infections in three patients.

Three patients had hematogenous infections caused by the same organism (as determined by identical antibiotic sensitivity profiles) in more than one joint. In each of the patients, the same infecting organism had also been recovered from a previous distant infection. Evidence that sepsis resulted from late hematogenous contamination is overwhelming. All three cases clearly had at least some late total joint infection which was not from organisms introduced at the time of total hip arthroplasty but from hematogenous contamination from a distant site occurring at a late date unknown to the surgeon. Patients with a total joint arthroplasty should probably have systemic antibiotic coverage to protect the prosthetic joint against hematogenous contamination from distant sites of infection and from potential bacteremia induced during medical or dental procedures.