From the Guidelines
Aspiration of the bursal fluid is the recommended diagnostic and therapeutic approach for infective elbow bursitis, with empiric antibiotic therapy started immediately after aspiration, typically with an anti-staphylococcal agent such as cephalexin or dicloxacillin for 10-14 days, as supported by the most recent evidence from 1. The fluid should be sent for Gram stain, culture and sensitivity, cell count, crystal analysis, and glucose level to confirm infection and identify the causative organism. Key considerations for diagnosis and management include:
- Ultrasound (US) is useful for detecting fluid, including joint effusions, abscesses, and infected tendon sheaths, with a sensitivity and specificity of 96.7% and 85.7%, respectively, for diagnosing an abscess, as reported by 1.
- Empiric antibiotic therapy should be started immediately after aspiration, with consideration of the patient's allergy history and potential for MRSA.
- The affected elbow should be rested, elevated, and ice applied intermittently to reduce inflammation.
- Repeated aspirations may be necessary if fluid reaccumulates, and patients should be monitored closely for improvement within 48-72 hours.
- Surgical drainage is indicated for cases that fail to respond to aspiration and antibiotics, have loculated collections, or show extensive tissue involvement, as suggested by 1 and 1.
From the Research
Elbow Fluid for Infective Bursitis
- The management of septic bursitis, including elbow fluid, typically involves examination of aspirated bursal fluid to differentiate between aseptic and septic bursitis 2.
- Ultrasonography can be useful for assisting in the diagnosis and guiding the aspiration of bursal fluid 2.
- Staphylococcus aureus is responsible for a significant proportion of cases of superficial septic bursitis, including those affecting the elbow 3, 2.
Treatment Options
- The use of antibiotics, such as cefazolin, is a common treatment approach for septic bursitis, including infective bursitis of the elbow 3, 4.
- Cefazolin has been shown to be effective in preventing surgical site infections, including those related to total joint arthroplasty 4.
- The choice of antibiotic may depend on various factors, including the presence of comorbid illnesses and the results of culture-proven cases 3.
Fluid Analysis
- The analysis of elbow fluid can help diagnose infective bursitis and guide treatment decisions 2.
- The presence of certain microorganisms, such as Staphylococcus aureus, can inform the selection of antibiotics 3, 2.
- Further research is needed to establish standardized recommendations for the management of septic bursitis, including the analysis of elbow fluid 2.