Septic Bursitis

1. See Also
   1. Acute Olecranon Bursitis
   2. Prepatellar Bursitis
2. Mechanism
   1. Often follows acute trauma
3. Causes
   1. Staphylococcus aureus (80% of cases)
   2. Streptococcus species
   3. Enterococcus
   4. Escherichia coli
   5. Pseudomonas aeruginosa
4. Symptoms
   1. Fever
   2. Bursal pain, redness and swelling
5. Signs
   1. Inflammation of skin overlying bursa
      1. Bursa erythema, warmth, and effusion
   2. Restricted joint range of motion
      1. Red flag for deep infection
6. Labs
   1. Complete Blood Count with differential
      1. May show Leukocytosis with Left Shift
7. Diagnosis: Aspirate Bursa
   1. Rising MRSA rate dictates culture-directed therapy
   2. See Bursa Aspiration
8. Imaging
   1. Ultrasound indications
      1. Deep infection suspected
      2. Guidance for Bursa Aspiration
9. Management
   1. General measures
      1. Moist heat
      2. Splinting
      3. Repeated aspiration or incision, drainage as needed
   2. Antibiotics
      1. Cover Staphylococcus and Streptococcus
      2. Modify antibiotics based on culture of aspirate
      3. Duration of therapy: 14-21 days
      4. Mild infection
         1. First-line antibiotics
            1. Oral: Dicloxacillin
            2. IV: Cefazolin, Oxacillin or Nafcillin
         2. Alternatives
            1. Clindamycin
            2. Trimethoprim-sulfamethoxazole
      5. Severe infection
         1. Start with Vancomycin IV
         2. Transition to oral agents based on culture results
10. References
    1. UpToDate (references 12/19/06)
    2. Koutouzis (2006) Marx: Rosen's Emergency Med
    3. Small (2005) Infect Dis Clin North Am 19:991-1005
    4. Lopez (2006) Infect Dis Clin North Am 20:759-72