Anaerobic septic bursitis

Soft tissue disease

In the assessment of patients with soft tissue complaints, it is important to consider infectious etiologies in the differential diagnosis, especially in immunocompromised hosts. The exact categorization of some bacterial infections of the soft tissues may be difficult. The structures potentially involved include the skin, subcutaneous tissue, fascia, and skeletal muscle. Classification is usually based upon the anatomic structure involved, the infecting organism, and the clinical picture. The categorization is complicated by the fact that some infections may involve several soft tissue components and multiple bacterial species. In this review, we will cover cutaneous and subcutaneous tissue infections, fasciitis, septic bursitis, tendonitis, and pyomyositis.

Septic bursitis

Nine cases of septic bursitis are presented, and the literature on the subject comprehensively reviewed, with an emphasis on the clinical manifestations of septic bursitis in various anatomic locations. Physical activities associated with increased susceptibility to septic bursitis and systemic conditions that increase the severity of septic bursitis are catalogued. Analysis of the microbiology of cases reported in the literature demonstrates that greater than 80% of cases of septic bursitis are caused by Staphylococcus aureus and other gram-positive organisms. However, a wide variety of gram-negative microorganisms, fungi, and other infectious agents have been reported to cause septic bursitis and may lead to complications in diagnosis and treatment. The nine cases reported here demonstrate the potential severity of septic bursitis and emphasize that significant systemic complications may result from this common musculoskeletal infection. Indications for hospitalization and/or intravenous antibiotic therapy for septic bursitis include the presence of fulminant local infection, evidence for systemic toxicity, or infection in an immunocompromised patient. Patients who fail to respond to intravenous antibiotics and percutaneous aspiration of the bursa may require surgical drainage or bursectomy by one of several methods that have been proposed. There is some recent evidence that intrabursal corticosteroid injection for therapy of nonseptic subcutaneous bursitis may be more effective than systemic antiinflammatory medication or simple bursa aspiration.

Septic bursitis: experience in a community practice

We reviewed 47 episodes of septic bursitis occurring in a private community medical practice. Most patients were male (85%), and roughly half (49%) the cases were related to recreational or occupational trauma. About 72% of cases were located in the olecranon bursa, while the remaining cases were prepatellar. Prepatellar bursitis patients were more likely to be hospitalized. Staphylococcus aureus was isolated from 70% of bursal fluid aspirations; other etiologic organisms included gram negative bacteria and Mycobacterium marinum. The majority of patients were able to be treated as outpatients with oral antibiotics. All patients were eventually cured without serious complications.

Predisposing factors, bacteriology and antibiotic therapy in 35 cases of septic bursitis

In a retrospective study the etiology was verified in 35/52 patients with suspected septic prepatellar or olecranon bursitis. Staphylococcus aureus was the most common pathogen and 86% of them were penicillinase-producing. Other strains were streptococci. Mean age was 47 (18-83) years and males predominated (91%). Predisposing factors were seen in most cases. Preceding trauma was found in 27 and/or associated diseases (e.g. diabetes mellitus) in 11 patients. Hyperglycemia was found in 38% of the patients. Treatment with antimicrobial agents, mostly penicillins, and bursal drainage were successful in 32 cases. Two patients had local spread of the infection and 1 patient chronic bursitis.