Comparison of nonseptic and septic bursitis. Further observations on the treatment of septic bursitis.

Of 30 cases of olecranon and prepatellar bursitis, ten were septic. Fever, tenderness, peribursal cellulitis, and skin involvement over the bursa were more common in the septic cases. A high leukocyte count, low bursal-to-serum glucose ratio, and positive Gram-stained smear of the bursal fluid distinguished septic from nonseptic bursitis. Rheumatoid arthritis and gout may be accompanied by nonseptic bursitis. Septic bursitis may be associated with a sympathetic sterile effusion in a neighboring joint or adjacent fascial space. The duration of antibiotic treatment necessary to sterilize bursal fluid was proportional to the length of time infection had been present. A prospective antibiotic program disclosed an average of 12 days for successful therapy. A bactericidal agent against penicillin-resistant Staphylococcus aureus is the drug of choice.