Original article
Microbiology of Pediatric Orbital Cellulitis

https://doi.org/10.1016/j.ajo.2007.04.049Get rights and content

Purpose

To evaluate the microbiology of pediatric orbital cellulitis associated with sinusitis.

Design

Retrospective review of medical records of pediatric patients treated for orbital cellulitis.

Methods

All pediatric patients treated for orbital cellulitis associated with sinusitis at Texas Children’s Hospital between December 1, 2001 and September 30, 2005 were reviewed. Data collected included patient age, history, microbiology results, and surgical intervention.

Results

Thirty-eight cases were identified. Fifteen cases required medical management, whereas 23 patients received a combination of medical and surgical intervention. Three patients had multiple surgical procedures performed. Of the procedures performed, four were sinus irrigation, 12 were sinusotomy and drainage, nine were orbitotomy with drainage of abscess, and one was craniotomy with drainage of abscess. Surgical aspirate specimens yielded a higher positive culture result rate with 9/9 of orbital abscesses and 13/16 of sinus aspirates demonstrating a positive yield. Two of the 27 blood cultures had a positive yield. Staphylococcus species was the most common organism isolated. Methicillin-resistant S. aureus (MRSA) represented 73% of S. aureus isolates. Streptococcus species was the next most common pathogen. Three cultures yielded Haemophilus species with one being positive for H. influenzae.

Conclusions

Organisms responsible for causing pediatric orbital cellulitis are evolving, with Staphylococcus followed by Streptococcus species being the most common pathogens. The occurrence of MRSA in pediatric orbital cellulitis is increasing, and empiric antimicrobial therapy should be directed against these organisms if they are prevalent in the community. Sinus and orbital abscess aspirates yielded the greatest number of positive cultures, though these invasive surgical procedures should be performed only when clinically indicated.

Section snippets

Methods

The medical records of all patients age 18 years and younger who presented to the Texas Children’s Hospital in Houston, Texas, for orbital cellulitis between December 1, 2001 and September 30, 2005 were reviewed. In an effort to identify all cases of orbital cellulitis during this period, patients were identified from the hospital database using International Classification of Disease codes corresponding to periorbital cellulitis (373.13), acute sinusitis (461.8), acute orbital inflammation

Results

Thirty-eight cases of pediatric orbital cellulitis were identified and included for analysis. The average age of all patients was 6.8 years and ranged from one week to 16 years. Fifteen cases required only medical management, whereas 23 patients received a combination of medial and surgical intervention to resolve the infection. Three of the 23 patients had multiple surgical procedures performed such as concurrent orbitotomy, craniotomy, or sinusotomy, or repeat sinusotomy. Of the procedures

Discussion

Before the introduction of the HiB vaccine in 1985, H. influenzae was the most common pathogen isolated in patients with orbital cellulitis.9, 12 This organism was extremely virulent and bacteremia and meningitis occurred frequently in pediatric patients with H. influenzae orbital cellulitis.9, 10, 13 For this reason, aggressive systemic evaluation for bacteremia and meningitis was always recommended in patients with orbital cellulitis.10, 14 Studies after the introduction of the HiB vaccine

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