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Namita Bhardwaj, Adham al-Hariri; Orbital and Preseptal Cellulitis: Our Experience at a Referral Center in Southeast Louisiana. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5343.
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To describe the characteristics and treatment of patients diagnosed with orbital and preseptal cellulitis at a tertiary care center in New Orleans, Louisiana.
The medical charts for all patients treated for orbital or preseptal cellulitis at Ochsner Medical Center from January 1, 2005 to July 1, 2012 were reviewed. Data collected included: demographics, risk factors, microbiology of aspirates and blood cultures, antibiotic choice, and the need for hospitalization and/or surgical intervention.
The charts of 158 patients (58.2% female, mean age 32.2 ± 25.7 years) with a diagnosis of orbital or preseptal cellulitis were reviewed. Orbital cellulitis was diagnosed in 25 (15.8%) patients and preseptal cellulitis was diagnosed in 133 (84.2%) patients. Imaging was performed to confirm the diagnosis in 48.1% of patients. The most common risk factor identified was sinusitis in 13 (8.2%) patients followed by trauma in 12 (7.6%) patients. Medical treatment was initiated in 100% of patients and 17 (10.8%) patients also underwent surgical intervention. Of the surgical procedures performed, 8 (5.1%) patients underwent orbitotomy and 4 (2.5%) underwent endoscopic exploration. Three (1.9%) patients developed complications that necessitated evisceration or enucleation. Of the 55 patients who underwent aspiration of an associated abscess, 47 (85.5%) demonstrated a positive culture yield. The most common organism isolated was Methicillin-resistant Staphylococcus aureus in 28/47 (59.6%) aspirates, followed by Methicillin-sensititive Staphylococcus aureus in 6/47 (12.8%), then coagulase-negative Staphylococcus in 5/47 (10.6%). Of the 57 patients with blood cultures drawn, 8 (14.0%) had positive cultures. Hospitalization was required in 73 (46.2%) patients and parental antibiotics were required in 93 (58.9%) patients. The most commonly prescribed class of antibiotic was glycopeptides in 52 (32.9%) patients followed by cephalosporins in 45 (28.5%). Of note, 87/158 (55.1%) patients were on 3 or more classes of antibiotics.
This study raises awareness regarding the high frequency of multi-drug regimens prescribed for orbital and preseptal cellulitis contributing to the increasing prevalence of resistant organisms and frequent hospitalization required for these diagnoses in this community.
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