Septic bursitis

Abstract

Nine cases of septic bursitis are presented, and the literature on the subject comprehensively reviewed, with an emphasis on the clinical manifestations of septic bursitis in various anatomic locations. Physical activities associated with increased susceptibility to septic bursitis and systemic conditions that increase the severity of septic bursitis are catalogued. Analysis of the microbiology of cases reported in the literature demonstrates that greater than 80% of cases of septic bursitis are caused by Staphylococcus aureus and other gram-positive organisms. However, a wide variety of gram-negative microorganisms, fungi, and other infectious agents have been reported to cause septic bursitis and may lead to complications in diagnosis and treatment. The nine cases reported here demonstrate the potential severity of septic bursitis and emphasize that significant systemic complications may result from this common musculoskeletal infection. Indications for hospitalization and/or intravenous antibiotic therapy for septic bursitis include the presence of fulminant local infection, evidence for systemic toxicity, or infection in an immunocompromised patient. Patients who fail to respond to intravenous antibiotics and percutaneous aspiration of the bursa may require surgical drainage or bursectomy by one of several methods that have been proposed. There is some recent evidence that intrabursal corticosteroid injection for therapy of nonseptic subcutaneous bursitis may be more effective than systemic antiinflammatory medication or simple bursa aspiration.

Evaluation of current treatment regimens for prepatellar and olecranon bursitis in Switzerland

“…The reported mean duration of antibiotic administration, 11.0 ± 5.1 days, is congruent with the literature on patients presenting with mild to moderate SB [3,5,17,20,22,25,27]. However, we detected a huge variation (3-28 days) for operated cases, not to mention the 27 % of colleagues who do not routinely use antibiotics.…”

“…A comparable regimen was used by Martinez-Taboada et al [5] on 82 patients with SB, although 12 % required secondary surgical intervention. According to the literature, surgical intervention is only recommended in cases of failed conservative treatment, critically ill patients, or in cases with complications [3,4,14,22]. However, the ideal surgical approach is unknown.…”

“…[1] variables used to differentiate between SB and NSB, [2] difference in skin temperature between the affected and unaffected bursa, [3] intrabursal steroid injection is only indicated if NSB is verified by culture, [4] number chosen arbitrarily by the authors fluclaxacillin) or a first-generation cephalosporin (e.g., cefazolin) [1,3,4,7,10,17,20,26], unless Gram stain or other factors (e.g., allergies to antibiotics) suggest otherwise [22]. Considering that more than 95 % of bursitis pathogens are methicillin-sensitive cocci (S. aureus, streptococci), this coverage is certainly good, but it may be extensive.…”

Behandlung der traumatisch eröffneten Bursa olecrani und der chronischen Bursitis olecrani

“…B. Cefalexin) sowie alternativ Clindamycin (bei schweren Verläufen Vancomycin und Rifampicin-Kombinationstherapie) über 10 Tage behandelt werden [11,25]. Neben der historischen Hauttemperaturdifferenz [26] ist das einzig sichere Verfahren zur Unterscheidung gegenüber der aseptischen Burisitis die Kulturanlage des Bursa-Aspirats [27,28]. Bei purulentem Aspirat oder klinischem Verdacht auf eine septische Bursitis (Fieber >38°C, laborchemische Infektkonstellation, immunsupprimierter Patient) sollte eine Antibiose erfolgen [29].…”

“…Bei purulentem Aspirat oder klinischem Verdacht auf eine septische Bursitis (Fieber >38°C, laborchemische Infektkonstellation, immunsupprimierter Patient) sollte eine Antibiose erfolgen [29]. Bei ausbleibender klinischer Rekonvaleszenz steht auch hier die operative Bursektomie als Therapieoption am Ende [28], welche auch in endoskopischer Technik durchgeführt werden kann [30,31], jedoch komplikationsbehaftet ist [22,32,33].…”