Septic Bursitis Treatment

Medical attention should be sought promptly for suspected septic bursitis. Treatment will include antibiotic medication to eliminate the infection and prevent the infection from spreading to other parts of the body. In addition, the infectious fluid may be drained from the bursa (needle aspiration) or the bursa may be surgically removed, which is known as a bursectomy.

Antibiotic Treatment for Septic Bursitis

Research suggests¹Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016 Jan;25(1):158-67. doi: 10.1016/j.jse.2015.08.032. Epub 2015 Nov 11. Review. PubMed PMID: 26577126.^,2Deal JB Jr, Vaslow AS, Bickley RJ, Verwiebe EG, Ryan PM. Empirical Treatment of Uncomplicated Septic Olecranon Bursitis Without Aspiration. J Hand Surg Am. 2019 Aug 14;. doi: 10.1016/j.jhsa.2019.06.012. [Epub ahead of print] PubMed PMID: 31421940. that most cases of septic bursitis can be treated with prompt oral antibiotic therapy. Specific recommendations regarding the type of antibiotic, dosage, and duration of treatment will depend on the individual. If the infection is advanced, or if the patient has other complicating factors, antibiotics may need to be administered intravenously.

Selection of antibiotics
To be effective, an antibiotic must target the infectious bacteria. A bacterium called Staphylococcus aureus is involved in more than 80% of septic bursitis cases.³Zimmermann B 3rd, Mikolich DJ, Ho G Jr. Septic bursitis. Semin Arthritis Rheum 1995;24:391-410. As cited in Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016 Jan;25(1):158-67. doi: 10.1016/j.jse.2015.08.032. Epub 2015 Nov 11. Review. PubMed PMID: 26577126.^,4Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis . Joint Bone Spine. 2019 Oct;86(5):583-588. doi: 10.1016/j.jbspin.2018.10.006. Epub 2018 Oct 26. PubMed PMID: 31615686. Other cases often involve streptococci, coagulase-negative staphylococci, enterococci, and Escherichia coli.⁴Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis . Joint Bone Spine. 2019 Oct;86(5):583-588. doi: 10.1016/j.jbspin.2018.10.006. Epub 2018 Oct 26. PubMed PMID: 31615686. About 10% of cases involve more than one microorganism.³Zimmermann B 3rd, Mikolich DJ, Ho G Jr. Septic bursitis. Semin Arthritis Rheum 1995;24:391-410. As cited in Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016 Jan;25(1):158-67. doi: 10.1016/j.jse.2015.08.032. Epub 2015 Nov 11. Review. PubMed PMID: 26577126.

Septic bursitis is more likely to become chronic when it is caused by an atypical microbe⁵Truong J, Ashurst JV. Septic Bursitis. 2019 Jan;. Review. PubMed PMID: 29262131. that does not adequately respond to traditional antibiotic treatment.

The only way to definitively know which microorganism(s) are causing the infection is to remove fluid from the bursa and test it.

Needle Aspiration for Septic Bursitis

A doctor may drain the bursa’s excess fluid with a needle and syringe. This process is called needle aspiration or arthrocentesis. The aspirated fluid is typically tested to confirm the infection and/or find out what strain of bacterium is causing the infection.

See What Is Arthrocentesis (Joint Aspiration)?

Aspiration can also provide immediate relief of pressure and discomfort.

See The Joint Aspiration Procedure

Needle aspiration may not be recommended if there is a skin infection or wound at the site of the needle insertion, as this may trigger or spread infection.⁶Blackwell JR, Hay BA, Bolt AM, Hay SM. Olecranon bursitis: a systematic overview. Shoulder Elbow 2014;6:182-90. http://dx.doi.org/10.1177/1758573214532787. If a needle aspiration is not possible, a doctor may recommend a minor surgical procedure to drain the bursa.

See Arthrocentesis Recovery and Potential Risks

Surgery for Septic Bursitis

Occasionally, surgery will be recommended to treat septic bursitis. The surgeon may perform:

• Incision and drainage. An incision is made into the skin directly over the bursa and the bursa’s contents are drained. This procedure is typically done only when septic bursitis is suspected and if aspiration is not possible.⁷Raddatz DA, Hoffman GS, Franck WA. Septic bursitis: presentation, treatment and prognosis. J Rheumatol 1987; 14: 1160–1163. As cited in Blackwell JR, Hay BA, Bolt AM, Hay SM. Olecranon bursitis: a systematic overview. Shoulder Elbow. 2014;6(3):182–190. doi:10.1177/1758573214532787 An open incision allows the doctor to clean and disinfect the wound.
• Bursectomy. A surgeon removes the inflamed bursa in a procedure called bursectomy or bursa resection. If a bursectomy is performed, it is typically done immediately after an incision and drainage.

Several months following a bursectomy, a new bursa will usually grow back in place of the one that was removed.

Why a Needle Aspiration or Surgery May Not Be Done

Not all doctors will recommend needle aspiration or surgery. Recent evidence suggests that draining fluid from the bursa is not necessary for the treatment of septic bursitis.¹Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016 Jan;25(1):158-67. doi: 10.1016/j.jse.2015.08.032. Epub 2015 Nov 11. Review. PubMed PMID: 26577126.^,2Deal JB Jr, Vaslow AS, Bickley RJ, Verwiebe EG, Ryan PM. Empirical Treatment of Uncomplicated Septic Olecranon Bursitis Without Aspiration. J Hand Surg Am. 2019 Aug 14;. doi: 10.1016/j.jhsa.2019.06.012. [Epub ahead of print] PubMed PMID: 31421940. There is debate over this approach. Many patients may recover faster and more comfortably with only antibiotic treatment. However, without a lab-tested fluid sample it is possible the prescribed antibiotics will be unnecessary or not effectively treat the symptoms.⁸Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg 2016;25:158–67. As cited in Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis. Joint Bone Spine. 2019 Oct;86(5):583-588. doi: 10.1016/j.jbspin.2018.10.006. Epub 2018 Oct 26. PubMed PMID: 31615686.

There are no universal guidelines on treating septic bursitis.⁹Khodaee M. Common Superficial Bursitis. Am Fam Physician. 2017 Feb 15;95(4):224-231. PubMed PMID: 28290630. Treatment recommendations will be tailored to the patient based on factors such as the severity of the infection, patient’s health status, and the doctor’s clinical experience.