II. Mechanism
- Often follows acute Trauma
III. Causes
- Staphylococcus aureus (80-85% of cases)
- Streptococcus Pyogenes and other species
- Staphylococcus Epidermidis
- Enterococcus (rare)
- Escherichia coli (rare)
- Pseudomonas aeruginosa (rare)
- Candida (rare)
IV. Risk Factors (present in 50% of cases)
- Diabetes Mellitus
- Chronic Kidney Disease
- Rheumatic disorders
- Alcoholism
- Immunocompromised state
V. Symptoms
- Fever (variably present)
- Bursal pain, redness and swelling
VI. Signs
- Inflammation of skin overlying bursa
- Bursa erythema, warmth, and effusion
- Restricted joint range of motion
- Red flag for deep infection
VII. Labs
-
Complete Blood Count with differential
- May show Leukocytosis with Left Shift
-
Bursa Aspiration
- Bursal fluid PMNs >1000/mm3 suggests Septic Bursitis
- Rising MRSA rate dictates culture-directed therapy
- See Bursa Aspiration
VIII. Imaging
-
Ultrasound indications
- Deep infection suspected
- Guidance for Bursa Aspiration
IX. Management
-
General measures
- Moist heat
- Splinting
- Repeated aspiration or incision, drainage as needed
- Antibiotics
- Cover Staphylococcus and Streptococcus
- Modify antibiotics based on culture of aspirate
- Duration of therapy: 14-21 days
- Shorter courses may be effective, and are not a risk for recurrent infection
- Perez (2010) J Antimicrob Chemother 65(5): 1008-14 +PMID:20197288 [PubMed]
- Mild infection
- First-line antibiotics
- Oral: Dicloxacillin
- IV: Cefazolin, Oxacillin or Nafcillin
- Alternatives
- Clindamycin
- Trimethoprim-sulfamethoxazole
- First-line antibiotics
- Severe infection (treat as presumed MRSA)
- Start with Vancomycin IV
- Alternatives: Linezolid, Daptomycin
- Transition to oral agents based on culture results
X. References
- (2016) Sanford Guide, accessed on IOS 2/16/2017
- (2006) UpToDate, accessed 12/19/06
- Koutouzis (2006) Marx: Rosen's Emergency Med
- Small (2005) Infect Dis Clin North Am 19:991-1005 [PubMed]
- Lopez (2006) Infect Dis Clin North Am 20:759-72 [PubMed]
- Khodaee (2017) Am Fam Physician 95(4): 224-31 [PubMed]
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Related Studies (from Trip Database) Open in New Window
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 122482001 |
| Italian | Borsite infettiva, Borsite infettiva NAS, Borsite settica |
| Dutch | bursitis infectieus NAO, septische bursitis, bursitis; infectieus, infectieus; bursitis, bursitis infectieus |
| French | Bursite septique, Bursite infectieuse SAI, Bursite infectieuse |
| German | septische Bursitis, Bursitis infektioes NNB, infektioese Bursitis |
| Portuguese | Bursite séptica, Bursite infecciosa NE, Bursite infecciosa |
| Spanish | Bursitis séptica, Bursitis infecciosa NEOM, bolsa serosa infectada (trastorno), bolsa serosa infectada, bursitis infecciosa, Bursitis infecciosa |
| Japanese | 感染性滑液包炎ＮＯＳ, 化膿性滑液包炎, 感染性滑液包炎, ｶﾉｳｾｲｶﾂｴｷﾎｳｴﾝ, ｶﾝｾﾝｾｲｶﾂｴｷﾎｳｴﾝ, ｶﾝｾﾝｾｲｶﾂｴｷﾎｳｴﾝNOS |
| English | septic bursitis, septic bursitis (diagnosis), Bursitis infective NOS, Septic bursitis, bursitis infective (diagnosis), bursitis infective, Bursitis infective, Infected bursa (disorder), Infected bursa, Infectious bursitis, bursitis; infective, infective; bursitis |
| Czech | Septická burzitida, Infekční burzitida NOS, Infekční burzitida |
| Hungarian | infectiv bursitis, infectiv bursitis k.m.n., Septicus bursitis |
Ontology: Infected olecranon bursa (C1960184)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 426002008 |
| English | Infected olecranon bursa, Infected olecranon bursa (disorder) |
| Spanish | bolsa serosa del olécranon infectada (trastorno), bolsa serosa del olécranon infectada |
Ontology: Infection of prepatellar bursa (C1998036)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 429670004 |
| English | Infection of prepatellar bursa (disorder), Infection of prepatellar bursa |
| Spanish | infección de bolsa serosa prerrotuliana (trastorno), infección de bolsa serosa prerrotuliana |
