II. Mechanism

  1. Often follows acute Trauma

III. Causes

  1. Staphylococcus aureus (80-85% of cases)
  2. Streptococcus Pyogenes and other species
  3. Staphylococcus Epidermidis
  4. Enterococcus (rare)
  5. Escherichia coli (rare)
  6. Pseudomonas aeruginosa (rare)
  7. Candida (rare)

IV. Risk Factors (present in 50% of cases)

V. Symptoms

  1. Fever (variably present)
  2. Bursal pain, redness and swelling

VI. 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

VII. Labs

  1. Complete Blood Count with differential
    1. May show Leukocytosis with Left Shift
  2. Bursa Aspiration
    1. Bursal fluid PMNs >1000/mm3 suggests Septic Bursitis
    2. Rising MRSA rate dictates culture-directed therapy
    3. See Bursa Aspiration

VIII. Imaging

  1. Ultrasound indications
    1. Deep infection suspected
    2. Guidance for Bursa Aspiration

IX. 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
      1. Shorter courses may be effective, and are not a risk for recurrent infection
      2. Perez (2010) J Antimicrob Chemother 65(5): 1008-14 +PMID:20197288 [PubMed]
    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 (treat as presumed MRSA)
      1. Start with Vancomycin IV
      2. Alternatives: Linezolid, Daptomycin
      3. Transition to oral agents based on culture results

X. References

  1. (2016) Sanford Guide, accessed on IOS 2/16/2017
  2. (2006) UpToDate, accessed 12/19/06
  3. Koutouzis (2006) Marx: Rosen's Emergency Med
  4. Small (2005) Infect Dis Clin North Am 19:991-1005 [PubMed]
  5. Lopez (2006) Infect Dis Clin North Am 20:759-72 [PubMed]
  6. Khodaee (2017) Am Fam Physician 95(4): 224-31 [PubMed]

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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
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