Septic Bursitis

INTERN MORNING REPORT 10/22/14

Etiology and Pathogenesis 150 bursae in the human body

Bacterial inoculation, spread from soft tissue, or hematogenous

Superficial bursae – direct inoculation or contiguous spread◦ Separate skin from deeper tissues

Prepatellar or infrapatellar – athletes or those with kneeling occupations

Predisposing factors – amount of bursal fluid, loss of skin integrity, impaired immune response

Presentation Pain and peribursal erythema and warmth, often in setting of DM, EtOHism, or immune supression

Fever, peribursal edema and pain on movement

Adjacent joint motion intact compared to septic arthritis

Leukocytosis, elevated ESR and CRP

Diagnosis History of trauma not helpful

Marked warmth and erythema

Puncture wound or abrasion

Aspiration of fluid – when effusion is present

Cell count, gram stain, and culture

Ddx: cellulitis, crystal induced, acute monoarthritis, osteo

Treatment Antibiotics and drainage

80% staph aureus, strep also common

Inflammation if gram stain is negative

Mild- dicloxacillin, clinda, doxy

Severe – vanc , then cefazolin

Duration of therapy 3-4 weeks, aspirate until bursal fluid sterile or no longer accumulates

Sources www.uptodate.com