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

Abstract

Purpose Bursitis is a common entity. However, evidence for the best treatment procedures is lacking, with management concepts varying internationally. We evaluated current treatment regimens for septic (SB) and nonseptic (NSB) prepatellar (PB) and (OB) olecranon bursitis in Switzerland and compared them to the published literature. Methods A voluntary 23-item online survey was distributed amongst all registered Swiss infectiologists and orthopedic surgeons in December 2011. The literature comparison was based on a systematic literature review. Results Overall response rate was 14 % (n = 117); 11 % (n = 92) were included in the final analysis. The overwhelming majority (91 %) of the respondents differentiated between SB and NSB, with determination predominantly based on clinical presentation (83 %), blood chemistry (75 %), and bursal aspirate (66 %). NSB was predominantly treated conservatively via immobilization (78 %) and antiinflammatory medication (73 %). For SB, 85 % indicated surgical intervention, with 73 % prescribing concomitant antibiotics. Regarding antibiotic choice, 90 % used an aminopenicillin or its derivatives for a mean of 11 ± 5 days. The literature review revealed 66 relevant publications with an overall level of evidence of 2b, arguing for a conservative treatment approach in cases of SB or NSB. Conclusion Therapeutic regimens for OB/PB differed considerably within Switzerland. Surgical intervention and antibiotic treatment was the most common therapy for SB, whereas a conservative approach predominated for NSB, which contrasts with the international literature. Clearly, prospective multicenter and multidisciplinary studies are needed to identify an optimal and cost-saving approach to the treatment of these common clinical entities.

Clinical Outcomes Following Open Olecranon Bursa Excision for Septic and Aseptic Olecranon Bursitis: An Observational Study

“…This methodology also may have resulted in the misclassification of some patients as septic when they were truly aseptic. However, due to the inherent limitations of medical records, we felt that this was the best available method to distinguish septic from aseptic bursitis and is supported by the findings of Baumbach et al [25]. Furthermore, our sample size was limited due to this study requiring preoperative and postoperative patient-reported outcomes.…”

Optimal antibiotics duration following surgical management of septic olecranon bursitis: a 12-year retrospective analysis

“…The optimal duration of postoperative antibiotics remains uncertain. In a study by Baumbach et al (2013a) surveying Swiss infectious diseases and orthopedic surgeons regarding the management of septic bursitis, a range of postoperative antibiotic durations were reported, varying between 3 and 28 d. Moreover, 25 of the 92 (27 %) surveyed physicians did not routinely prescribe antibiotics postoperatively (Baumbach et al, 2013a). In our cohort, excluding initial bacteremia or osteomyelitis, the median postoperative antibiotic course was 21 d, although with wide variability in both the route and duration of antibiotic treatment, ranging from 0 to 102 d. In a study by Perez et al (2010), a short antibiotic course (≤ 7 d) following bursectomy for olecranon or prepatellar septic bursitis in immunocompetent patients was not associated with an increased risk of infection relapse compared with longer courses (8-14 or > 14 d).…”

“…Surgery is typically reserved for select cases such as those involving refractory or relapsing infection, critically ill patients, presence of extensive peribursal soft tissue involvement requiring debridement, presence of a bursal abscess that fails needle aspiration, or for patients with chronic draining sinus (Baumbach et al, 2014;Small and Ross, 2005;Zimmermann et al, 1995). The ideal surgical approach (incision and drainage vs. bursectomy) remains debated (Lormeau et al, 2019;Baumbach et al, 2013a). In patients undergoing bursectomy, a one-stage procedure was effective, safe, and associated with lower rates of wound dehiscence compared with the two-stage approach (Uçkay et al, 2017).…”

“…Estimates suggest that both septic olecranon and prepatellar bursitis account for 0.01 % to 0.1 % of all hospital admissions (Mcafee and Smith, 1988), with half of these patients necessitating surgical intervention (Sayegh and Strauch, 2014). While surgical indications are clearly outlined in certain situations, there is still a notable void in the existing literature when it comes to postopera-tive care, particularly concerning the administration of antibiotics, which varies considerably among different healthcare institutions (Baumbach et al, 2013a(Baumbach et al, , b, 2014Ho and Su, 1981;Perez et al, 2010;García-Porrúa et al, 1999).…”

Management of septic and aseptic prepatellar bursitis: a systematic review

“…Baumbach et al [7] documented 36 different treatment modalities for bursitis in Switzerland alone in 2013. Treatment is commonly divided by aetiology, separating septic and aseptic bursitis, with most cases amenable to non-operative treatment.…”