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El Zein S, Berbari E, LeMahieu AM, Jagtiani A, Sendi P, Virk A, Morrey ME, Tande A. Optimal antibiotics duration following surgical management of septic olecranon bursitis: a 12-year retrospective analysis. J Bone Jt Infect 2024; 9:107-115. [PMID: 38779581 PMCID: PMC11110802 DOI: 10.5194/jbji-9-107-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/26/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction: The absence of a standardized postoperative antibiotic treatment approach for patients with surgically treated septic bursitis results in disparate practices. Methods: We retrospectively reviewed charts of adult patients with surgically treated septic olecranon bursitis at Mayo Clinic sites between 1 January 2000 and 20 August 2022, focusing on their clinical presentation, diagnostics, management, postoperative antibiotic use, and outcomes. Results: A total of 91 surgically treated patients were identified during the study period. Staphylococcus aureus was the most common pathogen (64 %). Following surgery, 92 % (84 of 91 patients) received systemic antibiotics. Excluding initial presentations of bacteremia or osteomyelitis (n = 5 ), the median duration of postoperative antibiotics was 21 d (interquartile range, IQR: 14-29). Postoperative complications were observed in 23 % (21 of 91) of patients, while cure was achieved in 87 % (79 of 91). Active smokers had 4.53 times greater odds of clinical failure compared with nonsmokers (95 % confidence interval, 95 % CI: 1.04-20.50; p = 0.026 ). The highest odds of clinical failure were noted in cases without postoperative antibiotic administration (odds ratio, OR: 7.4). Conversely, each additional day of antibiotic treatment, up to 21 d, was associated with a progressive decrease in the odds of clinical failure (OR: 1 at 21 d). Conclusion: The optimal duration of antibiotics postoperatively in this study was 21 d, which was associated with a 7.4-fold reduction in the odds clinical failure compared with cases without postoperative antibiotics. Further validation through a randomized controlled trial is needed.
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Affiliation(s)
- Said El Zein
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elie F. Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Anil Jagtiani
- Department of Infectious Diseases, Kaiser Permanente Southern California, Fontana, CA, USA
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Abinash Virk
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark E. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aaron J. Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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2
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Darrieutort-Laffite C, Coiffier G, Aïm F, Banal F, Bart G, Chazerain P, Couderc M, Coquerelle P, Ducourau Barbary E, Flipo RM, Faudemer M, Godot S, Hoffmann C, Lecointe T, Lormeau C, Mulleman D, Piot JM, Senneville E, Seror R, Voquer C, Vrignaud A, Guggenbuhl P, Salliot C. 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis. Joint Bone Spine 2024; 91:105664. [PMID: 37995861 DOI: 10.1016/j.jbspin.2023.105664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
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.
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Affiliation(s)
- Christelle Darrieutort-Laffite
- Rheumatology Department, CHU de Nantes, Nantes, France; Nantes Université, Oniris, CHU de Nantes, Inserm, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000 Nantes, France
| | | | - Florence Aïm
- Orthopedic Unit and Osteoarticular Reference Center, GH Diaconesses Croix Saint-Simon, Paris, France
| | - Fréderic Banal
- Department of Rheumatology, Centre Hospitalier Universitaire Amiens Picardie, 80054 Amiens, France
| | - Géraldine Bart
- Internal Medicine and Rheumatology department, Percy Army Training Hospital, Clamart, France
| | - Pascal Chazerain
- Rheumatology Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 75020 Paris, France
| | - Marion Couderc
- Rheumatology Department, CHU Gabriel-Montpied, Clermont-Ferrand, France; Inserm/Imost, UMR 1240, Clermont-Ferrand, France
| | | | | | - René-Marc Flipo
- Department of Rheumatology, CHU de Lille, Université de Lille, 59000 Lille, France
| | - Maël Faudemer
- Rheumatology Department, CHU Saint-Antoine, 75012 Paris, France
| | - Sophie Godot
- Internal Medicine and Rheumatology department, Percy Army Training Hospital, Clamart, France
| | - Céline Hoffmann
- Emergency Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 75020 Paris, France
| | - Thibaut Lecointe
- Orthopedic surgery Department, CHU d'Orléans, Orléans University, 45067 Orléans, France
| | | | - Denis Mulleman
- EA6295 Nano Medicines & Nano Probes Research Group, University of Tours, Department of Rheumatology, CHRU de Tours, Tours, France
| | - Jean-Maxime Piot
- Rheumatology Department, Centre Hospitalier du Mans, Le Mans, France
| | - Eric Senneville
- Department of Infectious Diseases, Tourcoing Hospital, Tourcoing, France
| | - Raphaèle Seror
- Rheumatology Department, AP-HP, Hôpitaux Universitaires Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Centre of Immunology of Viral Infections and Autoimmune Diseases (IMVA), Inserm U1184, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | | | - Pascal Guggenbuhl
- Rheumatology Department, Hôpital Sud, CHU de Rennes, 35000 Rennes, France; Rennes University, Inserm, CHU de Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1317, 35000 Rennes, France
| | - Carine Salliot
- Rheumatology Department, CHU d'Orléans, Orléans University, 45067 Orléans, France.
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3
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Pohl NB, Brush PL, Toci GR, Heinle JT, Thomas A, Hornstein J, Aita D, Beredjiklian P, Katt B, Fletcher D. Clinical Outcomes Following Open Olecranon Bursa Excision for Septic and Aseptic Olecranon Bursitis: An Observational Study. Cureus 2023; 15:e43696. [PMID: 37724223 PMCID: PMC10505354 DOI: 10.7759/cureus.43696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background and objective Olecranon bursitis (aseptic or septic) is caused by inflammation in the bursal tissue. While it is typically managed with conservative measures, refractory cases may indicate surgical intervention. There is currently limited research about outcomes following bursal excision for both septic and aseptic etiologies. In light of this, the purpose of this study was to determine if patients experienced improvement following surgical olecranon bursa excision and to compare outcomes between septic and aseptic forms. Materials and methods A retrospective review was performed involving patients who underwent olecranon bursa excision from 2014 to 2021. Demographic data, patient characteristics, surgical data, and outcome-related data were collected from the medical records. Patients were classified into subgroups based on the type of olecranon bursitis (septic or aseptic). Preoperative and one-year postoperative 12-item short-form survey (SF-12) results and range of motion (ROM) outcomes were evaluated for the entire cohort as well as the subgroups. Results We included 61 patients in our study and found significant improvement in the Physical Component Scale 12 (PCS-12) score for all patients (42.0 vs. 45.5, p=0.010) following surgery. However, based on subgroup analysis, the aseptic group improved in PCS-12 following surgery (41.5 vs. 46.8, p<0.001), but the septic group did not (43.6 vs. 40.5, p=0.277). No improvements were found in the Mental Component Scale 12 (MCS-12) scores following surgery in either group. Eighteen of the 61 patients experienced postoperative complications (29.5%), but only 6.5% required a second surgical procedure. Specifically, 14 of the 18 complications occurred in the aseptic group while two septic and two aseptic patients required additional surgeries. Elbow ROM did not change significantly after surgery but more patients were found to have full ROM postoperatively (83.0% to 91.8%, p=0.228). Conclusion Our findings suggest that patients with refractory olecranon bursitis, particularly if aseptic, tend to gain significant physical health benefits from open bursectomy.
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Affiliation(s)
- Nicholas B Pohl
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Parker L Brush
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Gregory R Toci
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Jeremy T Heinle
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Anna Thomas
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Joshua Hornstein
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Daren Aita
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Brian Katt
- Division of Hand Surgery, Hackensack Meridian Ocean Medical Center, Brick Township, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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Brown OS, Smith TO, Parsons T, Benjamin M, Hing CB. Management of septic and aseptic prepatellar bursitis: a systematic review. Arch Orthop Trauma Surg 2022; 142:2445-2457. [PMID: 33721054 DOI: 10.1007/s00402-021-03853-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite contributing to significant morbidity in working-age adults, there is no consensus on the optimal treatment for prepatellar bursitis. Much of the existing literature combines prepatellar and olecranon bursitis. This systematic review aims to determine the optimal management of prepatellar bursitis. STUDY DESIGN AND METHODS A primary search of electronic published and unpublished literature databases from inception to November 2019 was completed. Articles over 25 years old, case reports with less than four patients, paediatric studies, and non-English language papers were excluded. Our primary outcome was recurrence after 1 year. Comparisons included endoscopic vs open bursectomy, duration of antibiotics. Methodological quality was assessed using the Institute of Health Economics and Revised Cochrane Risk of Bias scoring systems. Meta-analyses were conducted where appropriate. RESULTS In total 10 studies were included (N = 702). Endoscopic and open bursectomy showed no difference in recurrence after 1 year (OR 0.41, 95% CI 0.05-3.53, p = 0.67), and surgical complications (OR 1.44, 95% CI 0.34-6.08, p = 0.44). 80% endoscopically-treated patients were pain free after 1 year. Patients treated with antibiotics for less than 8 days were not significantly more prone to recurrence (2/17 vs 10/114, OR 0.66, 95% CI 0.13-3.29, p = 0.64) compared to 8 days plus at minimum 1 year post injury. CONCLUSIONS Our study represents the largest cohort of patients evaluating management strategies for prepatellar bursitis, and includes data not previously published. Endoscopic bursectomy is non-inferior to open bursectomy, enabling a shorter hospital stay. It also offers a relatively low risk of post-operative pain. Endoscopic bursectomy is a viable option to treat both septic and aseptic prepatellar bursitis. Our small cohort suggests recurrence and hospital stay are not improved with antibiotic treatment exceeding 7 days for septic prepatellar bursitis.
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Affiliation(s)
- Oliver S Brown
- St George's University Hospitals NHS Foundation Trust, London, UK. .,Trauma and Orthopaedic Department, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
| | - T O Smith
- Oxford University Hospitals, Oxford, UK
| | - T Parsons
- Epsom and St Helier Hospitals, London, UK
| | - M Benjamin
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - C B Hing
- St George's University Hospitals NHS Foundation Trust, London, UK
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Charret L, Bart G, Hoppe E, Dernis E, Cormier G, Boutoille D, Le Goff B, Darrieutort-Laffite C. Clinical characteristics and management of olecranon and prepatellar septic bursitis in a multicentre study. J Antimicrob Chemother 2021; 76:3029-3032. [PMID: 34293150 DOI: 10.1093/jac/dkab265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND No current guidelines are available for managing septic bursitis (SB). OBJECTIVES To describe the clinical characteristics and management of olecranon and prepatellar SB in five French tertiary care centres. METHODS This is a retrospective observational multicentre study. 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 favourable response to antibiotic therapy. RESULTS We included 272 patients (median age of 53 years, 85.3% male and 22.8% with at least one comorbidity). A microorganism was identified in 184 patients (67.6%), from bursal fluids in all but 4. We identified staphylococci in 135 samples (73.4%), streptococci in 35 (19%) and 10 (5.5%) were polymicrobial, while 43/223 bursal samples remained sterile (19.3%). Forty-nine patients (18%) were managed without bursal fluid analysis. Antibiotic treatment was initially administered IV in 41% and this route was preferred in case of fever (P = 0.003) or extensive cellulitis (P = 0.002). Seventy-one (26%) patients were treated surgically. A low failure rate was observed (n = 16/272, 5.9%) and failures were more frequent when the antibiotic therapy lasted <14 days (P = 0.02) in both surgically and medically treated patients. CONCLUSIONS Despite variable treatments, SB resolved in the majority of cases even when the treatment was exclusively medical. The success rate was equivalent in the non-surgical and the surgical management groups. However, a treatment duration of <14 days may require special attention in both groups.
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Affiliation(s)
- Laurie Charret
- Rheumatology Department, CHU Nantes, Nantes, France.,Rheumatology Department, CHD Vendée, La Roche-Sur-Yon, France
| | - Géraldine Bart
- Rheumatology Department, CHU Rennes, Rennes, France.,Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043, Rennes cedex, France
| | | | | | | | - David Boutoille
- Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043, Rennes cedex, France.,Department of Infectious Diseases, CHU Nantes, Nantes, France.,Centre d'Investigation Clinique, Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, Nantes, France
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6
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Surgical Management of a Large Chronic Prepatellar Bursitis: 2-Stage Technique. Case Rep Orthop 2020; 2020:3204014. [PMID: 32395360 PMCID: PMC7201794 DOI: 10.1155/2020/3204014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/21/2019] [Indexed: 11/23/2022] Open
Abstract
Treatment of a large chronic prepatellar bursitis can be difficult to manage surgically because of a high rate of local complications and a significant chance of recurrence. We present a 2-stage technique using negative pressure dressings which produced a good outcome with no recurrence at one year after surgery.
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Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis. Joint Bone Spine 2018; 86:583-588. [PMID: 31615686 DOI: 10.1016/j.jbspin.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Christian Lormeau
- Service de rhumatologie, centre hospitalier de Niort, 40, avenue Charles-de-Gaulle, 79021 Niort, France.
| | - Grégoire Cormier
- Service de rhumatologie, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85928 La Roche-sur-Yon, France
| | - Johanna Sigaux
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
| | - Cédric Arvieux
- Clinique des maladies infectieuses, CHU de Rennes Pontchaillou, rue Henri-Le-Guilloux, 35043 Rennes, France; Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043 Rennes cedex, France
| | - Luca Semerano
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
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