Septic bursitis: Difference between revisions
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*Procedure | *Procedure | ||
**Placed in flexed position, elbow and forearm rested on surface | **Placed in flexed position, elbow and forearm rested on surface | ||
**Prep and | **Prep and drape | ||
**Plus/minus local anesthesia skin wheal | **Plus/minus local anesthesia skin wheal | ||
**Approach with 18-22 ga needle from posterior aspect of bursa, aspirate until bursa is flat | **Approach with 18-22 ga needle from posterior aspect of bursa, aspirate until bursa is flat | ||
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**Cell counts > 5000 - 20,000/µL depending on source | **Cell counts > 5000 - 20,000/µL depending on source | ||
***Predominance of PMNs | ***Predominance of PMNs | ||
***Cell counts < 2000/µL, with predominant mononuclear cells highly suggestive of nonseptic bursitis | ***Cell counts < 2000/µL, with a predominant mononuclear cells highly suggestive of nonseptic bursitis | ||
**Gram stain and culture | **Gram stain and culture | ||
***Gram stain with variable levels of sensitivities | ***Gram stain with variable levels of sensitivities | ||
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*[[Bursitis]] | *[[Bursitis]] | ||
==External Links== | |||
*Septic Bursitis: ED Presentation, Evaluation, and Management on [http://www.emdocs.net/septic-bursitis-ed-presentation-evaluation-and-management/ emDocs.net] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
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[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:ID]] | |||
Latest revision as of 11:55, 24 June 2023
Background
- Most common sites are prepatellar bursa and olecranon bursa
Clinical Features
- Acute pain, tenderness, warmth, and erythema of affected bursa
- None of which is seen in aseptic bursitis
- Fever (<50%)
Differential Diagnosis
Evaluation[1]
- Plain radiograph, CT, MRI usually not helpful
- US may help guide procedures or help with diagnostic uncertainty
- Bursal fluid aspiration
- Both diagnostic and therapeutic
- Do not perform if there is evidence overlying cellulitis
- Procedure
- Placed in flexed position, elbow and forearm rested on surface
- Prep and drape
- Plus/minus local anesthesia skin wheal
- Approach with 18-22 ga needle from posterior aspect of bursa, aspirate until bursa is flat
- Compressing bursa to help with aspiration
- Arthrocentesis should be performed if joint involvement suspected
- Septic workup
- Cell counts > 5000 - 20,000/µL depending on source
- Predominance of PMNs
- Cell counts < 2000/µL, with a predominant mononuclear cells highly suggestive of nonseptic bursitis
- Gram stain and culture
- Gram stain with variable levels of sensitivities
- Thus, high WBC count with negative gram stain should not exclude diagnosis
- Elevated protein
- Reduced glucose
- Crystal analysis
- Cell counts > 5000 - 20,000/µL depending on source
Management
Antibiotics
Cover Staphylococcus aureus (80-90%) and Streptococcus
Outpatient Options
- Clindamycin 300 mg PO three times daily x 14 days OR
- TMP/SMX 2 DS tabs PO two times daily x 14 days OR
- Dicloxacillin 500mg PO q6hr x10 days
Treatment followup with primary physician is important since the regimen may need extension to 3 weeks.
Inpatient Options
- Vancomycin 25-30 mg/kg IV loading then 15-20 mg/kg IV OR
- Clindamycin 600 mg (10/mg/kg) IV three times daily
- Linezolid 600 mg IV BID (10mg/kg Q8hrs for pediatrics)
Disposition
- Consider admission for:
- Extensive purulent bursitis
- Extensive surrounding cellulitis
- Suspected joint involvement
- Immunocompromised
- Failure to respond to course of PO antibiotics
See Also
External Links
- Septic Bursitis: ED Presentation, Evaluation, and Management on emDocs.net
References
- ↑ Lohr KM et al. Bursitis workup. eMedicine. NOV 2017. https://emedicine.medscape.com/article/2145588-workup#c8