Septic Bursitis in the Prepatellar and Olecranon Bursae

Abstract

Five cases of septic prepatellar and 20 cases of septic olecranon bursitis are reported. All were men, with a mean age of 47 years. Seventeen had a history of recent trauma to the affected limb or sustained pressure on knees or elbows, or both, required by certain occupations. Septic bursitis was not associated with septic arthritis and could be easily distinguished from it by the characteristic bursal swelling and joint examination. Septic bursitis was misdiagnosed as nonseptic bursitis in eight cases despite characterstic bursal fluid leukocytosis (greater than 1000 cells/mm3) and recovery of bacteria on culture. Staphylococcus aureus was identified in 22 cases; 76% were resistant to penicillin. Intravenous antibiotics and bursal fluid drainage were uniformly succesful. Oral antibiotic ttherapy was also successful unless the infection was extensive or there was underlying bursal disease. Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis.

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.…”

“…The high frequency of surgical interventions contrasts with the international literature, but is in line with contemporary German-language textbooks [12,13,15]. The international literature argues for conservative treatment in cases of SB and NSB [7,19,20], comprising serial bursal aspiration, PRICE schema, anti-inflammatory medication for NSB [12,13,15], and additional antibiotics for SB [3,7,9,14,17,20,21], with high success rates and few complications reported. To cite two examples, García-Porrúa et al [11] successfully applied a nonsurgical treatment approach with serial bursal aspiration and antibiotics to 75 patients with SB.…”

“…Differentiation was predominantly based on clinical presentation, blood chemistry and blood cultures, bursal aspirate, and bursal fluid culture. However, in the literature, clinical presentation (i.e., bursal swelling, redness, and tenderness) was not found to be suitable for differentiating between SB and NSB according to various studies [7,10,17,18]. Based on the evidence available, initial differentiation should be based on bursal temperature, bursal fluid analysis (white cell count, glucose, polymorphonuclear cell count), Gram staining, and gross aspirate characteristics [2,7,10,17,18], all of which were mentioned by less than 50 % of our Swiss colleagues.…”

“…When it comes to the choice of antimicrobial regimen, nearly 90 % of the surveyed colleagues favored amoxicillin/clavulanate, and only 6 % chose a first-or second-generation cephalosporin. The literature advises antistaphylococcal/antistreptococcal antibiotics [17,[24][25][26], such as penicillinase-resistant penicillin (e.g., …”

“…[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.…”