From the Guidelines
The treatment of septic olecranon bursitis requires prompt antibiotic therapy and drainage, with initial management including empiric antibiotics targeting Staphylococcus aureus, such as cefazolin 1-2g IV every 8 hours or clindamycin 600-900mg IV every 8 hours if penicillin-allergic, as recommended by the Surviving Sepsis Campaign guidelines 1.
Key Considerations
- Bursal aspiration is essential for diagnosis and therapeutic drainage, with fluid sent for culture and sensitivity testing.
- Surgical incision and drainage is indicated for cases with loculations, extensive purulence, or failure to respond to needle aspiration.
- Once culture results return, antibiotics should be tailored accordingly, typically continuing for 10-14 days total.
- Patients can be transitioned to oral antibiotics (such as cephalexin 500mg four times daily or clindamycin 300-450mg four times daily) once clinically improving with decreasing pain, erythema, and normalization of inflammatory markers.
Management Principles
- The elbow should be immobilized with a posterior splint, elevated, and ice applied intermittently to reduce inflammation.
- Close follow-up is necessary to monitor response, with repeat aspiration sometimes required for recurrent fluid accumulation.
- Failure to treat septic bursitis properly can lead to osteomyelitis, septic arthritis, or systemic infection, making aggressive early management crucial for optimal outcomes, as emphasized by the Surviving Sepsis Campaign guidelines 1.
Antibiotic Therapy
- Empiric broad-spectrum therapy with one or more antimicrobials for patients presenting with sepsis or septic shock to cover all likely pathogens (including bacterial and potentially fungal or viral coverage) is recommended 1.
- Antimicrobial regimen should be reassessed daily for potential de-escalation, as suggested by the 2018 WSES/SIS-E consensus conference recommendations 1.
From the Research
Treatment Options for Septic Olecranon Bursitis
- The treatment for septic olecranon bursitis may involve antibiotic therapy, with or without bursal aspiration, and in some cases, surgical intervention 2, 3, 4, 5.
- Antibiotic treatment can be administered intravenously (IV) or orally, and the choice of antibiotic may depend on the suspected or confirmed causative microorganism 2, 3, 6, 5.
- A study found that empiric antibiotic therapy without bursal aspiration may be a reasonable initial approach to managing select patients with suspected septic olecranon bursitis, with a high success rate of uncomplicated resolution 3.
Surgical Intervention
- Surgical intervention, such as open bursectomy or arthroscopy, may be considered in cases where antibiotic therapy is not effective or in cases with significant bursal tissue damage 2, 6, 4.
- A case study reported a successful outcome with surgical treatment and antibiotic combination therapy for a patient with olecranon bursitis caused by Mycobacterium gordonae 6.
Duration of Antibiotic Therapy
- The duration of antibiotic therapy may vary, but a study suggested that a treatment duration of less than 14 days may be associated with a higher failure rate 2.
- Another study found that empirical management without aspiration may be effective, with most cases resolving with a single course of empirical antibiotics 5.
Bursal Aspiration
- Bursal aspiration may be performed to obtain a sample for culture and sensitivity testing, but some studies suggest that empiric antibiotic therapy without aspiration may be a viable alternative in select cases 3, 5.
- A study found that aspiration may not always be necessary, and empirical management without aspiration may be considered in cases of uncomplicated septic olecranon bursitis 5.