In addition to aiding in diagnosis, bursal aspiration for a patient with septic bursitis can improve symptoms and reduce bacterial load.1-3,8 The use of a compressive bandage after aspiration may help reduce re-accumulation of the bursal fluid.1-3,8Staphylococcus aureus is responsible for the majority of septic olecranon bursitis cases.9-11
Tailoring the antibiotic regimen
There is wide variation in the treatment of septic olecranon bursitis due to the lack of strong evidence-based guidelines.1,2,8,11-13 When septic bursitis is strongly suspected (or confirmed) the patient should be started on an antibiotic regimen that covers S aureus.1,2 Once culture results and sensitivities return, the antibiotic regimen can be tailored appropriately.
In cases of mild-to-moderate septic olecranon bursitis in an immunocompetent host, the patient can be started on oral antibiotics and monitored closely as an outpatient.1-3,8 Patients with septic olecranon bursitis who meet the criteria for systemic inflammatory response syndrome or who are immunocompromised should be hospitalized and started on intravenous antibiotics.1-3 Recommended duration of antibiotic therapy varies but is usually about 10 to 14 days.1-3,8 In rare cases, surgical intervention with bursectomy may be necessary.1,2,14
Our patient was given a dose of ceftriaxone 250 mg intramuscularly and was started on oral sulfamethoxazole/trimethoprim 800 mg/160 mg twice daily after aspiration of the bursa. Culture of the bursal fluid grew oxacillin-sensitive S aureus which was sensitive to a variety of antibiotics including levofloxacin and sulfamethoxazole/trimethoprim. Her symptoms gradually improved (FIGURE 3) and resolved after a 14-day course of oral sulfamethoxazole/trimethoprim.
PHOTO COURTESY OF MORTEZA KHODAEE, MD, MPH
CORRESPONDENCE
Morteza Khodaee, MD, MPH, University of Colorado School of Medicine, Department of Family Medicine & Orthopedics, AFW Clinic, 3055 Roslyn St, Denver, CO 80238; morteza. khodaee@cuanschutz.edu