Epidemiology and Management of Orbital Cellulitis in Children

Abstract

Background The epidemiology of orbital cellulitis likely has evolved due to the emergence of methicillin-resistant Staphylococcus aureus (MRSA) and the adoption of pneumococcal conjugate vaccination. In the absence of published guidelines, management is highly variable. We characterized epidemiology and management over an 11-year period. Methods A retrospective cohort study of children 0 to 21 years of age with orbital cellulitis +/− subperiosteal orbital abscess hospitalized at a large quaternary children’s hospital from January 2008 to June 2018. We reviewed charts for demographic characteristics, clinical features, management, and outcomes. Using multivariable logistic regression, we evaluated predictors of surgical intervention and assessed whether corticosteroid use or antibiotic duration was related to clinical outcomes. Results Among 220 patients, methicillin-susceptible S. aureus was the most common organism (26.3%), with MRSA found in only 5.0%. Rates of vancomycin use fluctuated annually from 40.9% to 84.6%. Surgery was performed in 39.5% of the patients. Corticosteroids, used in 70 patients (32.1%), were unrelated to treatment failure (n = 9), defined as persistent signs and symptoms or initial clinical improvement followed by worsening (P = .137). The median antibiotic duration was 17 days (interquartile range 14-26). After controlling for age, gender, proptosis, eye pain with movement, eyelid swelling, neutrophil count, and corticosteroid use, treatment failure was not significantly associated with receipt of ≥ 3 weeks of antibiotic therapy (8/84, 9.5%) compared with > 2 but < 3 weeks (0/51, 0.0%) or ≤ 2 weeks (1/85, 1.2%) (adjusted odds ratio = 5.83 for ≥ 3 vs ≤2 weeks; 95% confidence interval: 0.58, 59.0). Conclusions Although MRSA was rare, empiric vancomycin use was high. Treatment failure was uncommon in patients who received ≤ 2 weeks of therapy, suggesting that shorter durations are adequate in some patients.

clinical manifestations of pediatric patients with preseptal and orbital cellulitis in chongqing(Western China)

“…The proper use of effective antibiotics is crucial in the treatment of orbital cellulitis [14]. Due to the long duration of bacterial culture and drug sensitivity testing, empirical treatment is often used in clinical practice.…”

Bugs Behind the Bulging Eyeball: Microbiology and Antibiotic Management in Orbital Cellulitis With or Without Subperiosteal Abscess

“…In addition, our study further supports that Streptococcal species are more prevalent than S aureus, particularly MRSA as shown in other publications studying orbital cellulitis. 3,[10][11][12]17 Based on the bacterial etiology reported, specifically the low prevalence of MRSA infections, empiric antibiotics for treating orbital cellulitis could likely be safely narrowed from the current general practice. In spite of this, our study as well as Anosike et al 12 and Markham et al 3 found that most patients admitted for orbital cellulitis are still empirically started on combination therapy with MRSA coverage.…”

“…Similar to previously published studies, patients were excluded if postseptal involvement was not present on computed tomography or magnetic resonance imaging. 12,16 In addition, exclusion criteria included history of complex chronic condition based on the Feudtner criteria, 17 history of immunodeficiency, malignancy, preceding trauma/orbital surgery, repeat admissions, admission to the pediatric intensive care unit (PICU), inpatient transfers from another hospital, and intracranial involvement with abscess or sinus thrombosis.…”

“…8,10,11 In addition, the reported incidence of methicillin-resistant Staphylococcus aureus (MRSA) in orbital cellulitis has varied, with some studies noting an increase while others describe a downtrend. [11][12][13][14][15] In a time where antibiotic stewardship is crucial for addressing the public health concern of growing antibiotic resistance, the ability of physicians to choose narrow-spectrum antibiotics is essential. Trends in empiric treatment have continued to include combination therapy-typically 2 antibiotics of which one is targeted to treat MRSA.…”

“…Trends in empiric treatment have continued to include combination therapy-typically 2 antibiotics of which one is targeted to treat MRSA. 3,12 The objective of this study is to evaluate the present microbiology of orbital cellulitis and describe the current antibiotic management among hospitalized children.…”