Background/Purpose:

Septic bursitis (SB) is a common condition that typically involves the olecranon and patellar bursae. It is unclear whether patients with SB treated surgically differ in their clinical presentation and outcomes from patients treated with antibiotics alone. Furthermore, it is unknown if preceding trauma is a risk factor for more severe disease and higher rates of surgical intervention. Finally, the factors distinguishing patients with olecranon SB from those with patellar involvement are not well understood. The purpose of this study is to describe the clinical features and outcomes of patients with SB and to address these uncertainties. 

Methods:

We conducted a retrospective cohort study of patients 18 years and older admitted to a single tertiary care center from 1998 to 2015 with culture-proven olecranon and patellar (including prepatellar and infrapatellar) SB. Patients with concurrent septic arthritis or sterile bursal fluid cultures were excluded. Baseline characteristics and clinical features, microbial profile, rate of operative intervention, length of hospital stay (LOS), and 60-day readmission rate were determined. Patients were stratified by site of SB, presence or absence of preceding bursal trauma, and operative or non-operative management.

Results:

Of 44 cases of SB, 31 involved the olecranon bursa and 13 affected the patellar bursae. Patients with olecranon and patellar SB were similar with respect to age, male predominance and frequency of preceding bursal trauma. However, patients managed operatively were younger (mean 42.4 vs. 57.7 years; p = 0.05), as were those without preceding bursal trauma (mean 51.1 vs. 62.6 years; p = 0.05). Clinical features at presentation and presence of comorbidities were similar when patients were stratified by site of SB, history of preceding bursal trauma, or management strategy. The most common organisms isolated from bursal fluid were methicillin-sensitive Staph aureus (MSSA), methicillin-resistant Staph aureus (MRSA), and coagulase negative Staph. Patients managed operatively were discharged to rehabilitation less frequently (p=0.04) and had a lower rate of 60-day readmission than their conservatively managed peers (p = 0.05). A trend toward shorter mean LOS was observed among patients with preceding bursal trauma as compared to those without trauma (4.4 vs. 10.4 days; p = 0.07).

Conclusion:

In this study of SB, we were unable to identify factors that differentiate patients treated surgically from those treated conservatively. Similarly, there was no clear relationship between preceding trauma or site of SB and clinical course, management, or outcomes. Patients with SB treated surgically tended to be younger and have lower readmission rates. Additional study is needed to identify patients who would benefit from early surgical intervention for SB.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-and-outcomes-of-septic-bursitis/