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Daniel G. Straka, Ami A. Shah, Ruth Hill Yeilding, Louise A. Mawn; Age No Longer a Factor in Pediatric Orbital Cellulitis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1261.
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In the early 1990s following a retrospective review which found that children under the age of 9 had sterile or single isolate cultures in orbital cellulitis, many ophthalmologists have adapted the Harris criteria for the management of pediatric orbital cellulitis. We reviewed all pediatric patients presenting with orbital cellulitis to the Vanderbilt Childrens Hospital within the last 10 years to determine whether age is still a reliable factor in the assessment and management of pediatric orbital cellulitis
Retrospective review of all inpatient and outpatients with ICD-9 diagnosis of preseptal (373.13) or orbital cellulitis (376.01) seen at Vanderbilt University Children’s Hospital over ten years (August 1998-August 2008).
273 cases were reviewed, including 101 cases of orbital cellulitis. Of these 101 patients, wound culture was obtained in 38 patients, and 22 of these cultures were positive. Thirteen of the 22 patients were less than 9 (average age 2.68 years SD 2.28) and 9 of the 22 culture positive cases were older than 9 (average age 13.2 SD 1.99). Four of the children had aggressive methicillin resistant staphylococcus aureus and the remaining 9 children less than age 9 had virulent streptococcal infections.
The bacterial pathogens have once again shifted in pediatric orbital cellulitis and consequently, age can no longer be used as a factor in the clinical decision making for the treatment of children with orbital cellulitis. One must maintain a high degree of suspicion for virulent organisms, including MRSA, to ensure appropriate initial antibiotic therapy and early surgical intervention in children of all age groups.
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