Olecranon septic bursitis managed in an ambulatory setting

Background: The epidemiology, outcome and management of olecranon septic bursitis (OSB) have not been described in a large cohort of ambulatory patients. Methods: A retrospective study of all 118 cases of OSB presenting over 21 months to all regional Home Parenteral Therapy Program clinics in Calgary (referral base approximately 1 million). Results: The minimum population annual incidence was 10/100 000. The mean (and standard deviation) age was 44 (13) years, and males predominated (88%). One-third of patients had at least one comorbid illness, with preceding injury in 53% of cases. The most common symptoms were pain (87%), redness (77%) and fever or chills (45%). Common signs included erythema (92%), swelling (85%), edema (75%), tenderness (59%), fluctuance (50%), heat (36%) and reduced range of motion (27%). Fever (body temperature of ≥37.8°C) occurred in 20%. Staphylococcus aureus was identified in 88% of culture-proven cases of OBS. The most common antibiotic regimen was sequential intravenous administration of cefazolin (for a median of 4 d) followed by clindamycin orally (for a median of 8 d). Sixty (51%) patients required a drainage procedure and only 1 patient required admission to hospital. Conclusion: OSB is more common than reported and can be treated successfully in ambulatory settings with sequential intravenous therapy followed by oral therapy and drainage in selected cases.