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)

  1. Diabetes Mellitus
  2. Chronic Kidney Disease
  3. Rheumatic disorders
  4. Alcoholism
  5. Immunocompromised state

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]

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Infected bursa (C1290161)

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