Should We Tap That? Aspirates and Antibiotics: An Update on Septic Bursitis

Purpose of Review Septic bursitis is a relatively common condition that causes substantial morbidity, but there is no universally accepted approach to management. We aim to evaluate recent literature with an eye toward recommended changes in the practice of bursal aspiration, surgical debridement, and antibiotic treatment.Recent Findings Authors of recent studies suggest that most patients with uncomplicated septic bursitis can be treated nonoperatively, perhaps even without aspiration of the bursal sac, and can achieve satisfactory clinical response with antibiotics alone. Surgical debridement has not been shown to be superior to nonoperative approaches but is recommended for complex or refractory cases. Optimal antibiotic route and duration is largely determined by severity of the presentation, but many authors favor transition to oral antibiotic therapy early where appropriate.Summary There remains considerable heterogeneity regarding the best management of septic bursitis, ranging from aggressive surgical debridement to isolated antibiotic treatment. Bursal aspiration can help to guide antimicrobial therapy but is not necessarily a requirement in making the diagnosis if patients show an adequate response to empiric antibiotics. Close follow-up after initial presentation for patients with proven or suspected septic bursitis is important to determine their clinical response and to further guide their management.