Antibiotic management of septic bursitis without aspiration provides relief in ED patients

Des Plaines, IL – Eighty-eight percent of emergency department (ED) patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without need for subsequent bursal aspiration, hospitalization, or surgery. The findings suggest that empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis.

That is the conclusion of the article titled, Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in ED patients, to be published in the January 2022 issue of Academic Emergency Medicine (AEM), a peer-reviewed journal of the Society for Academic Emergency Medicine (SAEM).

There are only limited studies focused on ED evaluation and management of septic bursitis. Additionally, the efficacy of conservative management of suspected septic olecranon bursitis with empiric antibiotic therapy is unknown. The objective this study was to describe outcomes associated with empiric antibiotic therapy without bursal aspiration among ED patients with suspected septic olecranon bursitis.

The ED evaluation and diagnosis of septic bursitis is widely variable and often based on anecdotal evidence. Diagnostic aspiration of the olecranon bursa to assess for septic bursitis is commonly recommended and performed despite the paucity of evidence to support this practice. Aspiration may increase the risk for complications including chronic fistula formation, infection, and need for a future bursectomy.

The study found that eighty-nine percent of patients admitted to the hospital for empiric antibiotic management for whom follow-up was available did not undergo bursal aspiration in the ED or after admission and 100% of these patients had an uncomplicated resolution.

The lead author of the study is Adrian Beyde, MD, of the Mayo Clinic Alix School of Medicine in Rochester, Minnesota.

Commenting on the article is Neha P. Raukar, MD, MS, an associate professor of emergency medicine at the Mayo Clinic.

This is the first study that provides evidence that empiric antibiotics without aspiration is a reasonable initial approach for septic olecranon bursitis in a large proportion of ED patients. As with anything else, risks and benefits of empiric antibiotics should be carefully considered and return/follow up instructions are also important. However, in the right population, managing septic olecranon bursitis with empiric antibiotics can streamline care without sacrificing quality or outcomes, and will decrease both the amount of time patients stay in the ED and the risk of infection from painful procedures like tapping the bursa. This study is a game changer in that it will shift the way we manage these patients.