Inadvisable Treatment of Recalcitrant Septic Olecranon Bursitis: An Unusual Case of Extremely Prolonged Treatment With Oral Antibiotics After Bursectomy

Pitts,

doi:10.4021/jmc463w

Cited by 1 publication

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References 11 publications

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“…Oral amoxicillin 500mg every six hours was then prescribed, which he took for three months [ 20 , 21 ]. We speculated that this extended course of oral antibiotics following IV antibiotics was the consequence of several factors, including (1) the ability of C. acnes or another anaerobic bacteria species to form a biofilm, (2) our patient’s immunocompromised state and poor healing capacity as a result of his alcoholism and smoking, (3) prior case of septic bursitis leaving subcutaneous scar tissue, and (4) bone involvement [ 22 , 23 ]. However, as discussed below, we also realized that other biofilm-forming organisms that failed to grow in culture might have been the causal organism and C. acnes was a contaminant/superinfection.…”

Section: Case Presentationmentioning

confidence: 99%

Septic Olecranon Bursitis With Osteomyelitis Attributed to Cutibacterium acnes: Case Report and Literature Overview of the Dilemma of Potential Contaminants and False-Positives

Skedros¹,

Finlinson²,

Luczak³

et al. 2023

Cureus

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We report an unusual case of acute septic olecranon bursitis, with probable olecranon osteomyelitis, where the only organism isolated in culture was initially considered a contaminant, Cutibacterium acnes. However, we ultimately considered it the likely causal organism when treatment for most of the other more likely organisms failed. This typically indolent organism is prevalent in pilosebaceous glands, which are scarce in the posterior elbow region. This case illustrates the often challenging empirical management of a musculoskeletal infection when the only organism isolated might be a contaminant, but successful eradication requires continued treatment as if it is the causal organism. The patient is a Caucasian 53-yearold male who presented to our clinic with a second episode of septic bursitis at the same location. Four years prior, he had septic olecranon bursitis from methicillin-sensitive Staphylococcus aureus that was treated uneventfully with one surgical debridement and a one-week course of antibiotics. In the current episode reported here, he sustained a minor abrasion. Cultures were obtained five separate times because of no growth and difficulty eradicating the infection. One culture grew C. acnes on day 21 of incubation; this long duration has been reported. The first several weeks of antibiotic treatment failed to eradicate the infection, which we ultimately attributed to inadequate treatment of C. acnes osteomyelitis. Although C. acnes has a well-known propensity for false-positive cultures as typically reported in post-operative shoulder infections, treatment for our patient's olecranon bursitis/osteomyelitis was successful only after several surgical debridements and a prolonged course of intravenous and oral antibiotics that targeted it as the presumptive causal organism. However, it was possible that C. acnes was a contaminant/superinfection, and another organism was the culprit, such as a Streptococcus or Mycobacterium species that was eradicated by the treatment regime targeted for C. acnes.

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Section: Case Presentationmentioning

confidence: 99%