Background/Purpose: Septic bursitis (SB) is a common medical problem. However, there are no current guidelines for managing the condition. The study aims to describe the clinical characteristics and management of olecranon and patellar septic bursitis in five French tertiary care centers.

Methods: We performed a retrospective multicenter study. Patients over the age of 18 years requiring hospitalization for olecranon or prepatellar SB from January 1, 2016 to December 31, 2018 were included. SB was diagnosed on the basis of positive cultures of bursal aspirate. In the absence of positive bursal fluid, the diagnosis came from typical clinical presentation, exclusion of other causes of bursitis, and favorable response to antibiotic therapy. The following characteristics were collected: age, gender, occupation, and comorbidities, date of diagnosis, presence of fever > 38.5°C, extensive cellulitis and skin lesion, and NSAIDs intake during the episode. Finally, the results of biological tests (CRP, bursal fluid and blood cultures), management (antibiotic type, route and duration of administration, surgical drainage) and outcomes were obtained from patients’ charts. We considered the condition to be healed on the basis of data from follow-up consultations when the patient’s symptoms had resolved (pain, fever, skin lesions) or if the patients did not need to be referred again by their general practitioner. For statistics, quantitative data were compared using a Mann-Whitney test, and a Chi square test (or Fisher’s exact test for values < 5) was used for qualitative data. Values of p< 0.05 were considered significant.

Results: We included 272 patients (median age: 53, 85.3% male, manual occupation for 30.8% and 22.8% with at least one comorbidity). Fifty-one patients were taking NSAIDs to manage symptoms before diagnosis (18.3%). Fever was reported in 91 patients (33.4%) and a history of preceding knee/elbow injury or skin lesion was found in 161 patients (59.3 %). Median CRP level was 98.3 mg/L (range: 0-330). The bursal fluid was aspirated by puncture in 172 patients (63.2%) and collected during surgery in 51 patients (18.8%), while 49 patients (18%) were managed without bursal fluid analysis. A microorganism was identified in 80% of the samples (180/223). Bursal fluid analysis identified staphylococci in 73.4% and streptococci in 19%. Antibiotic treatment was initially administered intravenously (IV) in 41%, and this route was preferred in case of fever (p=0.003) or extensive cellulitis (p=0.002). When treatment was started IV, amoxicillin/clavulanate and oxa-/cloxacillin were most commonly given. When it was started orally, amoxicillin/clavulanate (44.7%) and pristinamycin (34%) were the most prescribed treatments. Twenty-six percent of patients (N=71) were treated surgically. A low failure rate was observed (N=16/272, 5.9%) and failures were more frequent when the antibiotic therapy lasted less than 14 days (p=0.02) in both surgically- and medically-treated patients.

Conclusion: Despite variable treatments, SB resolved in the majority of cases even when the treatment was exclusively medical. Antibiotic therapy shorter than 14 days was associated with more failures.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-and-management-of-olecranon-and-prepatellar-septic-bursitis-in-a-multicenter-study/