Septic bursitis

Revision as of 18:09, 13 October 2018 by Kxl328 (talk | contribs) (Evaluation)

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

  • 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

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

References