Info

🌱 來自: infectious arthritis and bursitis

olecranon and prepatellar bursitis

Epidemiology & risk factors (Joint Bone Spine 2019;86:583)

• 150 bursae in the body; 2 most commonly infected are olecranon and prepatellar

• Most commonly (esp. superficial bursae) due to direct trauma, percutaneous inoculation, or contiguous spread from adjacent infection (eg, cellulitis)
• Other risk factors: recurrent noninfectious inflammation (eg, gout, RA), diabetes
• S. aureus (80%) most common, followed by streptococci

Diagnosis

• Physical exam: discrete bursal swelling, erythema, maximal tenderness at ↣ center of bursa with preserved joint range of motion
• Aspirate bursa if concern for infxn, ✓ cell count, Gram stain, bacterial cx, crystals WBC >20k w/ poly predominance suspicious for bacterial infection, but lower counts very common (crystals do not rule out septic bursitis!)
• Assess for adjacent joint effusion, which can also be septic
• Do not tap through infected skin to avoid introducing infxn into bursa

Initial therapy

• Prompt empiric coverage for staphylococci and streptococci: PO abx acceptable for mild presentation; vancomycin if ill appearing; broaden spectrum based on risk factors
• Modify antibiotics based on Gram stain, culture results, & clinical course. Duration of Rx is → 1-3 wks. Serial aspirations every 1-3 d until sterile or no reaccumulation of fluid.
• Surgery if unable to drain bursa through aspiration, evidence of foreign body or necrosis, recurrent/refractory bursitis w/ concern for infxn of adjacent structures