From the Guidelines
Septic bursitis should be suspected when a bursa shows signs of infection including redness, warmth, severe tenderness, significant swelling, fever, and intense pain with movement, and treatment requires prompt medical attention with antibiotics, drainage, and supportive care. The signs of septic bursitis include:
- Redness and warmth of the affected area
- Severe tenderness and significant swelling
- Fever
- Intense pain with movement Treatment typically involves:
- Empiric antibiotics that cover Staphylococcus aureus, such as cefazolin 1-2g IV every 8 hours or clindamycin 600-900mg IV every 8 hours for those with penicillin allergy 1
- Aspiration of the bursa for both diagnosis and therapeutic drainage
- Resting the affected joint
- Applying ice to reduce inflammation
- Taking pain relievers like ibuprofen 400-600mg every 6-8 hours as needed Hospitalization is often required for IV antibiotics, with transition to oral antibiotics for a total 10-14 day course once improvement is seen. Drainage or debridement of the affected area should always be performed, and a 3-4 week course of therapy is suggested 1. It is crucial to note that septic bursitis requires aggressive treatment because the infection can spread to nearby joints or the bloodstream if left untreated, potentially causing sepsis or permanent joint damage.
From the Research
Signs of Septic Bursitis
- The most frequently involved sites are the olecranon (63%) and prepatellar (27%) bursae 2
- Staphylococcus aureus is the most common pathogen, responsible for 78% of cases 2 and 80% of cases of superficial septic bursitis 3
- Skin breakage, trauma, and/or occupational risk factors are significantly associated with infections 2
- Cellulitis adjacent to the affected bursae is frequent (89%) and often extensive 2
- Profound edema occurs in 11% of affected limbs 2
Treatment of Septic Bursitis
- The optimal management includes early recognition and prompt initiation of appropriate antibiotic therapy 4
- Surgical management may be necessary, and complications can arise from open procedures 4
- Endoscopic bursectomy may be considered for patients requiring surgical debridement, leading to decreased morbidity in those requiring surgical intervention 4
- Empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis 5
- Ceftriaxone is a consideration for definitive therapy of MSSA infection, with a lower risk of toxicity compared to antistaphylococcal antibiotics 6
- The management of septic bursitis varies considerably across centers, and controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery 3