Septic bursitis
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Transcript of Septic bursitis
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