Cloxacillin-based therapy in severe septic bursitis: retrospective study of 82 cases.
OBJECTIVE
The purpose of this retrospective study was to describe a tertiary care center experience with different antibiotic strategies that include cloxacillin (C) in patients with severe septic bursitis (SB).


METHODS
A severe SB was considered when the patient needed hospitalization and/or intravenous (i.v.) antibiotics. Patients were treated with bursal aspiration and one of these antibiotic options: C, 2 g/4 h per day i.v. until improvement, and afterwards 1 g/6 h per day v.o. until resolution; (C+G), gentamicin i.v. was added to C for 5 to 7 days (initial dose 240 mg/d); (C+R), rifampicin was added at a dose of 600 mg/d v.o.


RESULTS
The study comprised 82 patients with severe SB. The mean delay to diagnosis was 6.1+/-6.9 days, and the most frequent location was the prepatellar bursa. In 67%, the bursal fluid culture yield a positive result, being Staphylococcus aureus the most frequent bacteria isolated (94.4%). At admission, fever and extensive cellulites were more frequent in the C+G group. Patients in the C+G had a longer duration of i.v. antibiotics compared with the C group (p=0.008), although the total duration of antibiotics was not different. There was a tendency in the C+R group to need more surgery. All patients except one had a complete resolution and there were no differences in side effects.


CONCLUSIONS
In patients with severe SB without extensive cellulites i.v., C alone may be sufficient. In patients with a more severe presentation, C plus gentamicin seems to be an appropriate option in the majority of them.
Martinez-Taboada
Victor Manuel
VM
Division of Rheumatology, Hospital Universitario Marqués-de-Valdecilla, Servicio Cántabro de Salud, Facultad de Medicina, Universidad de Cantabria, Gerencia Atención Primaria, avenida Valdecilla s/n, 39008 Santander, Spain. vmartinezt@medynet.com
Cabeza
Rosario
R
Cacho
Pedro Muñoz
PM
Blanco
Ricardo
R
Rodriguez-Valverde
Vicente
V
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002061:Bursa, Synovial / Q000473:pathology / Q000601:surgery; D002062:Bursitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D003023:Cloxacillin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004551:Elbow Joint / Q000382:microbiology / Q000473:pathology; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006785:Hospitals, University; D006801:Humans; D007275:Injections, Intravenous; D007719:Knee Joint / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D003023:Cloxacillin; D012293:Rifampin