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Differences in characteristics, aetiologies, isolated pathogens, and the efficacy of antibiotics in adult patients with preseptal cellulitis and orbital cellulitis between 2000–2009 and 2010–2019
  1. En-Jie Shih1,2,3,
  2. Jui-Kuan Chen4,
  3. Pei-Jhen Tsai1,
  4. Youn-Shen Bee1,5,6
  1. 1Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  2. 2School of Medicine, National Yang Ming University, Taipei, Taiwan
  3. 3School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
  4. 4Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  5. 5Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
  6. 6Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
  1. Correspondence to Dr Youn-Shen Bee, Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan; ysbee{at}


Background/aims To understand whether the epidemiology, aetiologies, common pathogens and the antibiotic efficacy against the identified bacteria of periorbital cellulitis in adults have changed recently (2010–2019) compared with the past decade (2000–2009).

Methods Adult patients (n=224) diagnosed with preseptal cellulitis and orbital cellulitis admitted to Kaohsiung Veterans General Hospital during 2000–2019 were retrospectively reviewed. Demographic and clinical characteristics, isolated pathogens and antibiotic susceptibility tests against the commonly cultured bacteria were analysed.

Results Preseptal cellulitis showed a tendency of female predominance. Patients in their 60s showed an incidence peak; more cases were observed during winter. The most common predisposing factor was dacryocystitis (15.5%–30.5%), followed by hordeolum (15.5%–24.8%). Aetiology of sinusitis (p=0.001) decreased and that of conjunctivitis (p=0.007) increased significantly with time. Culture results of nasopharyngeal swabs and local abscess showed higher positivity rate than conjunctival swab. The most common isolates were methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, coagulase-negative staphylococci and Pseudomonas aeruginosa. Antibiotics including fluoroquinolones and vancomycin were effective; in contrast, ampicillin/sulbactam and oxacillin showed decreasing efficacy against gram-positive bacteria. For antibiotic treatment against P. aeruginosa, fluoroquinolones, ceftazidime, piperacillin and imipenem were ideal choices.

Conclusion In isolated pathogens, the increasing trend of methicillin-resistant S. aureus detection was compatible with reducing oxacillin efficacy against periorbital infection. In our study, the report of antibiotic efficacy against the most common identified bacteria offered empirical choices for hospitalised patients with periorbital infection before obtaining culture results.

  • microbiology
  • drugs
  • infection
  • orbit
  • treatment medical

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Contributors E-JS and Y-SB conceived and planned the study. E-JS collected the data and analysed the data with P-JT. E-JS wrote the manuscript. J-KC and Y-SB supervised the study and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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