Septic bursitis

Background

• Most common sites are prepatellar bursa and olecranon bursa

Clinical Features

• Acute pain, tenderness, warmth, and erythema of affected bursa
  • None of which is seen in aseptic bursitis
• Fever (<50%)

Differential Diagnosis

• Olecranon bursitis (nonseptic)
• Prepatellar bursitis (nonseptic)

Evaluation

• Bursal fluid aspiration
  • Both diagnostic and therapeutic
• Procedure
  • Placed in flexed position, elbow and forearm rested on surface
  • Prep and drap
  • Plus/minus local anesthesia skin wheal
  • Approach with 18-22 ga needle from posterior aspect of bursa, aspirate until bursa is flat
  • Compressing bursa to help with aspiration

Management

Antibiotics

Cover Staphylococcus aureus (80-90%) and Streptococcus

Outpatient Options

• Clindamycin 300 mg PO three times daily x 14 days OR
• TMP/SMX 2 DS tabs PO two times daily x 14 days OR
• Dicloxacillin 500mg PO q6hr x10 days

Treatment followup with primary physician is important since the regimen may need extension to 3 weeks.

Inpatient Options

• Vancomycin 25-30 mg/kg IV loading then 15-20 mg/kg IV OR
• Clindamycin 600 mg (10/mg/kg) IV three times daily
• Linezolid 600 mg IV BID (10mg/kg Q8hrs for pediatrics)

Disposition

• Consider admission for:
  • Extensive purulent bursitis
  • Extensive surrounding cellulitis
  • Suspected joint involvement
  • Immunocompromise
  • Failure to resopnd to course of PO antibiotics

See Also

• Bursitis