From the Guidelines
Septic bursitis should be treated with antibiotics and drainage, prioritizing the most recent and highest quality evidence available, which emphasizes the importance of prompt intervention to prevent serious complications such as sepsis, osteomyelitis, or joint infection 1.
Diagnosis and Treatment
The diagnosis of septic bursitis typically involves fluid aspiration from the bursa with culture to identify the specific bacteria and guide antibiotic therapy.
- The most commonly affected areas are the olecranon bursa (elbow) and prepatellar bursa (knee), often following trauma or skin infection.
- Staphylococcus aureus is the most common causative organism.
- For mild cases, oral antibiotics like cephalexin (500mg four times daily) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily) for 10-14 days may be sufficient.
- More severe cases require intravenous antibiotics such as cefazolin (1-2g every 8 hours) or vancomycin (15-20mg/kg every 12 hours) if MRSA is suspected.
Management
The infected bursa often needs drainage through needle aspiration or surgical incision.
- Rest, elevation, and warm compresses help reduce inflammation.
- Patients should seek immediate medical attention as delayed treatment can lead to serious complications.
- The choice of antibiotic should be guided by the results of the culture and sensitivity testing, as well as the severity of the infection and the patient's overall health status, as recommended by the Infectious Diseases Society of America 1.
From the Research
Diagnosis of Septic Bursitis
- The diagnosis of septic bursitis is typically based on clinical presentation and laboratory tests, including culture of the bursal fluid 2.
- The most common organism isolated from bursal fluid is Staphylococcus aureus 2.
Treatment of Septic Bursitis
- Empiric antibiotic therapy without bursal aspiration may be a reasonable initial approach to management of select patients with suspected septic olecranon bursitis 3, 4.
- Studies have shown that empirical management without aspiration can be effective in resolving septic olecranon bursitis, with fewer complications and no need for subsequent bursal aspiration, hospitalization, or surgery 3, 4.
- Surgical intervention, including endoscopic bursectomy, may be required in cases where conservative treatment fails 5.
- Endoscopic bursectomy has been shown to be a viable alternative to open bursectomy, with good results and fewer wound healing complications 5.
Management Approaches
- Non-operative management, including antibiotics and rest, may be sufficient for some patients with septic bursitis 2.
- Operative management, including bursectomy, may be necessary for patients who do not respond to non-operative management or have complicated cases 2, 5.
- The choice of management approach may depend on various factors, including the severity of the infection, the presence of trauma, and the patient's overall health status 2.