Empiric antibiotics, a noninvasive standard approach for treating olecranon bursitis in ED: Study

USA: A retrospective study by Adrian Beyde and team revealed that 88% of emergency department (ED) patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without the need for subsequent bursal aspiration, hospitalization, or surgery.

The findings of the study, published in the journal Academic Emergency Medicine, suggest that empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis. 

Septic bursitis accounts for about a third of bursitis cases. Olecranon bursa evaluation and aspiration are important for accurate diagnosis and management of the cause of the olecranon bursa swelling and pain. Recommendation of aspiration of the bursa prior to initiation of antimicrobial therapy though there is an absence of robust clinical data to support this practice and known risk of aspiration complications is mentioned in several guidelines.

Against the above background, Dr. Beyde and the team aimed to describe outcomes associated with empiric antibiotic therapy without bursal aspiration among ED patients with suspected septic olecranon bursitis. 

The study was a retrospective observational cohort study of patients presenting to an academic ED from January 1, 2011, to December 31, 2018, with olecranon bursitis. The health record was reviewed to assess patient characteristics and outcomes within 6 months of the ED visit. Olecranon bursitis was considered a "suspected septic" if the patient was treated with antibiotics. The primary outcome of interest was complicated versus uncomplicated bursitis resolution. The uncomplicated resolution was defined as bursitis resolution without subsequent bursal aspiration, surgery, or hospitalization.

A total of 264 ED patients were evaluated for 266 cases of olecranon bursitis. The median age was 57 years and 85% were men. 

The results of the study were:

• 1.5% of patients had bursal aspiration during their ED visit, 14.7% were admitted to the hospital, 28.6% were dismissed without antibiotic therapy, and 55.3% were dismissed with empiric antibiotic therapy for suspected septic olecranon bursitis.

• Among these 147 patients, 134 had follow-up available including 118 (88.1%) with an uncomplicated resolution, eight (6.0%) who underwent subsequent bursal aspiration, and nine (6.7%) who were subsequently admitted for inpatient antibiotics.

Beyde and team concluded that " Eighty- eight percent of ED patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without the need for subsequent bursal aspiration, hospitalization, or surgery. Our 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."

"To our knowledge, this represents the largest study of ED patients with olecranon bursitis," they wrote. 

Reference:

The study titled, "Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients," is published in the journal Academic Emergency Medicine.

DOI: https://onlinelibrary.wiley.com/doi/10.1111/acem.14406