Septic bursitis in immunocompromised patients

doi:10.1016/0002-9343(87)90895-3

The American Journal of Medicine

Volume 83, Issue 4, October 1987, Pages 661-665

https://doi.org/10.1016/0002-9343(87)90895-3 Get rights and content

Abstract

A retrospective analysis of 29 patients with septic bursitis was undertaken to ascertain if immunocompromised patients differed in their clinical presentations, type of organisms cultured, and outcome when compared with their non-immunocompromised cohorts. Thirty episodes of septic bursitis occurred in 29 patients, 43 percent of which occurred in immunocompromised patients. Despite similar clinical presentations, the bursae of immunocompromised patients took three times longer to sterilize and had a much higher bursal white blood cell count when compared with the bursae of non-immunocompromised patients. The bacteriologic spectrum was essentially identical in both groups; there were no cases in which gram-negative organisms were recovered from infected bursae. No cases of septic bursitis were seen in neutropenic patients. The most common factors contributing to an immunocompromised state were alcoholism or steroid therapy. A successful resolution of septic bursitis was seen in all the patients in the immunocompromised groups.

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Cited by (49)

2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis
2024, Joint Bone Spine
Septic bursitis (SB) is a common condition accounting for one third of all cases of inflammatory bursitis. It is often related to professional activities. Management is heterogeneous and either ambulatory or hospital-based, with no recommendations available. This article presents recommendations for managing patients with septic bursitis gathered by 18 rheumatologists from the French Society for Rheumatology work group on bone and joint infections, 1 infectious diseases specialist, 2 orthopedic surgeons, 1 general practitioner and 1 emergency physician. This group used a literature review and expert opinions to establish 3 general principles and 11 recommendations for managing olecranon and prepatellar SB. The French Health authority (Haute Autorité de santé [HAS]) methodology was used for these recommendations. Designed for rheumatologists, general practitioners, emergency physicians and orthopedic surgeons, they focus on the use of biological tests and imaging in both outpatient and inpatient management. Antibiotic treatment options (drugs and duration) are proposed for both treatment modalities. Finally, surgical indications, non-drug treatments and prevention are covered by specific recommendations.
Olecranon and prepatellar bursitis: A retrospective monocentric study of 88 cases
2023, Revue du Rhumatisme (Edition Francaise)
Les bursites sont une pathologie fréquente mais peu étudiée. L’objectif était de décrire les caractéristiques cliniques et la prise en charge des patients hospitalisés pour une bursite olécrânienne ou prépatellaire et de rechercher des facteurs prédictifs du caractère septique.
Il s’agit d’une étude rétrospective monocentrique sur les patients hospitalisés dans le service de rhumatologie de l’hôpital Bégin entre le 01/01/2000 et le 31/12/2019.
Sur les 88 patients inclus 80 % étaient des hommes, âgés en moyenne de 49,7 ans : 56,8 % avaient une bursite prépatellaire, 13,6 % une profession à risque de bursite, 19,3 % une immunodépression, 55,7 % une lésion locale préalable, 29,5 % de la fièvre ; 77,3 % des patients ont eu une ponction bursale et 47,7 % une échographie ; 67,6 % des bursites ponctionnées étaient septiques, dont 89,1 % à Staphylococcus aureus. Le seuil de 4700 éléments nucléés par mm³ dans le liquide de ponction avait le meilleur rapport sensibilité/spécificité (66 %/93 %). Le taux de bursite septique n’était pas significativement différent selon la présence de fièvre, d’immunosuppression, de lésion locale préalable et de profession à risque. Au total, 80,7 % des patients ont reçu un antibiotique, en majorité de l’oxacilline avec une durée moyenne de 2,6 semaines.
Les bursites sont une pathologie touchant principalement les hommes de 40 à 60 ans. S. aureus est le germe le plus fréquemment retrouvé dans les bursites septiques. L’anamnèse et l’examen clinique sont insuffisants pour prédire le caractère septique, rendant la ponction nécessaire pour identifier le germe.
Bursitis are a frequent disease but rarely studied. The objective was to describe the clinical characteristics and the management of patients hospitalised for an olecranon or prepatellar bursitis and to seek predictive factors of septic bursitis.
This is a retrospective monocentric study on patients hospitalised in the rheumatology department of the Begin hospital between 01/01/2000 and 12/31/2019.
Among 88 patients included, 80% were men with a mean age of 49.7 years: 56.8% had a prepatellar bursitis, 13.6% a high risk of bursitis professional activity, 19.3% an immunosuppression, 55.7% a preceding local lesion, 29.5% fever; 77.3% of the patients had a bursal aspiration and 47.7% a sonogram; 67.6% of the aspired bursitis were septic, with 89.1% of Staphylococcus aureus. The threshold of 4700 white blood cell per mm³ in the aspiration fluid had the best sensitivity/specificity ratio (62%/93%). The proportion of septic bursitis was not significatively different depending on the presence of fever, immunosuppression, preceding local lesion and high-risk professional activity. In all, 80.7% of the patients received antibiotics, mostly oxacillin for a mean duration of 2.6 weeks.
Bursitis is a disease concerning mostly men between 40 and 60 years old. S. aureus is the most frequent bacteria. Medical history and clinical exam are not able to predict if the bursitis is septic, rendering the aspiration mandatory to identify the bacteria.
Characteristics and management of olecranon or prepatellar septic bursitis
2023, Infectious Diseases Now
Septic bursitis
2022, Revue du Rhumatisme Monographies
Les bursites septiques olécraniennes et pré-patellaires sont un motif fréquent de consultation en médecine générale ou aux Urgences. Pourtant, aucune recommandation internationale n’est disponible pour la prise en charge de cette pathologie et l’analyse de la littérature montre une large variabilité des pratiques, les données disponibles étant issues principalement de séries rétrospectives. Dans cette revue, nous reprenons les données disponibles pouvant être utiles à la prise en charge des patients concernant le diagnostic et les options thérapeutiques.
Olecranon and prepatellar septic bursitis are a common medical problem. However, evidence regarding the management of septic bursitis is limited and no recommendations have been published. Previous studies showed considerable variability in treatment practices, the data available being mainly from retrospective series. The objective of the review was to synthesize the published data about the diagnosis and management of olecranon and patellar septic bursitis.
Management of septic bursitis
2019, Joint Bone Spine
Citation Excerpt :
The diagnostic yield of blood cultures is low, as bacteremia is relatively uncommon during superficial septic bursitis. The rate of blood culture positivity varied across studies from 4% to 30% [6,28,48]. The results of bursal fluid Gram staining vary even more widely, with positivity rates ranging from 15% to 100% [10,44].
Superficial septic bursitis is common, although accurate incidence data are lacking. The olecranon and prepatellar bursae are the sites most often affected. Whereas the clinical diagnosis of superficial bursitis is readily made, differentiating aseptic from septic bursitis usually requires examination of aspirated bursal fluid. Ultrasonography is useful both for assisting in the diagnosis and for guiding the aspiration. Staphylococcus aureus is responsible for 80% of cases of superficial septic bursitis. Deep septic bursitis is uncommon and often diagnosed late. The management of septic bursitis varies considerably across centers, notably regarding the use of surgery. Controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery.
Management of septic bursitis
2019, Revue du Rhumatisme (Edition Francaise)
Les bursites septiques superficielles, notamment olécraniennes et patellaires, sont des pathologies fréquentes, mais dont l’incidence n’est pas parfaitement connue. Le diagnostic clinique de bursite superficielle est simple, mais confirmer l’origine septique impose le plus souvent une ponction afin d’analyser le liquide bursal. L’échographie facilite le diagnostic et permet de guider le geste de ponction. Le principal germe responsable des bursites septiques superficielles est Staphylococcus aureus, en cause dans près de 80 % des cas. Les bursites septiques profondes sont rares et source de retard diagnostique. La prise en charge des bursites septiques est hétérogène. Les disparités de traitement selon les centres sont fréquentes, en particulier lors du recours à la chirurgie. Des études contrôlées sont nécessaires afin d’établir des recommandations pour homogénéiser les protocoles de traitement antibiotique et préciser les indications de la chirurgie.

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Septic bursitis in immunocompromised patients

Abstract

J Chronic Dis

Septic subcutaneous bursitis: report of sixteen cases

J Rheumatol

Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases

Ann Intern Med

Alternate day prednisone: leukocyte kinetics and susceptibility to infections

N Engl J Med