Difference between revisions of "Septic bursitis"
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==Background== | ==Background== | ||
*Most common sites are prepatellar bursa and olecranon bursa | *Most common sites are prepatellar bursa and olecranon bursa | ||
| + | |||
==Clinical Features== | ==Clinical Features== | ||
*Acute pain, tenderness, warmth, and erythema of affected bursa | *Acute pain, tenderness, warmth, and erythema of affected bursa | ||
**None of which is seen in aseptic bursitis | **None of which is seen in aseptic bursitis | ||
| − | *Fever (<50%) | + | *[[Fever]] (<50%) |
| − | ==Diagnosis== | + | ==Differential Diagnosis== |
| + | *[[Olecranon bursitis (nonseptic)]] | ||
| + | *[[Prepatellar bursitis (nonseptic)]] | ||
| + | *[[Cellulitis]] | ||
| + | *[[Septic arthritis]] | ||
| + | |||
| + | ==Evaluation<ref>Lohr KM et al. Bursitis workup. eMedicine. NOV 2017. https://emedicine.medscape.com/article/2145588-workup#c8</ref>== | ||
| + | *Plain radiograph, CT, MRI usually not helpful | ||
| + | *[[Musculoskeletal ultrasound|US]] may help guide procedures or help with diagnostic uncertainty | ||
*Bursal fluid aspiration | *Bursal fluid aspiration | ||
**Both diagnostic and therapeutic | **Both diagnostic and therapeutic | ||
| + | **Do not perform if there is evidence overlying cellulitis | ||
| + | *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 | ||
| + | **[[Arthrocentesis]] should be performed if joint involvement suspected | ||
| + | *Septic workup | ||
| + | **Cell counts > 5000 - 20,000/µL depending on source | ||
| + | ***Predominance of PMNs | ||
| + | ***Cell counts < 2000/µL, with predominant mononuclear cells highly suggestive of nonseptic bursitis | ||
| + | **Gram stain and culture | ||
| + | ***Gram stain with variable levels of sensitivities | ||
| + | ***Thus, high WBC count with negative gram stain should not exclude diagnosis | ||
| + | **Elevated protein | ||
| + | **Reduced glucose | ||
| + | **Crystal analysis | ||
| − | == | + | ==Management== |
| − | + | ===[[Antibiotics]]=== | |
| − | + | {{Septic Bursitis Antibiotics}} | |
| − | |||
| − | |||
| − | |||
==Disposition== | ==Disposition== | ||
*Consider admission for: | *Consider admission for: | ||
**Extensive purulent bursitis | **Extensive purulent bursitis | ||
| − | **Extensive surrounding cellulitis | + | **Extensive surrounding [[cellulitis]] |
| − | **Suspected joint involvement | + | **Suspected [[septic arthritis|joint involvement]] |
| − | ** | + | **Immunocompromised |
| − | **Failure to | + | **Failure to respond to course of PO antibiotics |
==See Also== | ==See Also== | ||
*[[Bursitis]] | *[[Bursitis]] | ||
| − | == | + | ==External Links== |
| − | * | + | *Septic Bursitis: ED Presentation, Evaluation, and Management on [http://www.emdocs.net/septic-bursitis-ed-presentation-evaluation-and-management/ emDocs.net] |
| + | ==References== | ||
| + | <references/> | ||
| + | |||
| − | [[Category: | + | [[Category:Orthopedics]] |
| + | [[Category:ID]] | ||
Latest revision as of 09:28, 26 June 2020
Contents
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
Evaluation[1]
- Plain radiograph, CT, MRI usually not helpful
- US may help guide procedures or help with diagnostic uncertainty
- Bursal fluid aspiration
- Both diagnostic and therapeutic
- Do not perform if there is evidence overlying cellulitis
- 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
- Arthrocentesis should be performed if joint involvement suspected
- Septic workup
- Cell counts > 5000 - 20,000/µL depending on source
- Predominance of PMNs
- Cell counts < 2000/µL, with predominant mononuclear cells highly suggestive of nonseptic bursitis
- Gram stain and culture
- Gram stain with variable levels of sensitivities
- Thus, high WBC count with negative gram stain should not exclude diagnosis
- Elevated protein
- Reduced glucose
- Crystal analysis
- Cell counts > 5000 - 20,000/µL depending on source
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
- Immunocompromised
- Failure to respond to course of PO antibiotics
See Also
External Links
- Septic Bursitis: ED Presentation, Evaluation, and Management on emDocs.net
References
- ↑ Lohr KM et al. Bursitis workup. eMedicine. NOV 2017. https://emedicine.medscape.com/article/2145588-workup#c8