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A. A. Shah, R. H. Yeilding, L. A. Mawn, S. P. Donahue; Pediatric Orbital Cellulitis: A Shift in the Microbiological Spectrum. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3531.
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In 1996, Donahue and Schwartz reported a decrease in theprevalence and incidence of Hemophilus Influenza B related preseptaland orbital cellulitis over the preceding decade. More recently, themedical community has observed an increase in the prevalence of skinand soft tissue infections caused by community-acquired methicillinresistant staph aureus (CA-MRSA). We reviewed all pediatric patientspresenting with orbital cellulitis to the Vanderbilt Childrens’Hospital within the last 10 years to determine whether anotherparadigm shift in the bacteriology has occurred.
Retrospective review of all inpatient and outpatients withan ICD-9 diagnosis of preseptal (373.13) or orbital cellulitis(376.01) seen at Vanderbilt University Childrens Hospital over tenyears (August 1998-August 2008).
273 cases were reviewed, including 100 cases of orbitalcellulitis. Of these 100 patients, wound culture was obtained in 38patients, and 26 of these cultures were positive. Of woundcultures showing growth, Streptococal species still remainedone of the most predominant isolates. There were 10 Streptococcal culture, 5 MRSA cultures, 1 Methicillin sensitive staph, and 2 H. flu The remaining cultures were polymicrobial. Five patients had documented positive MRSA cultures. Blood cultures were positive in 9 patients out of 78 total samples, and were positive for MRSA in 2 cases of orbital cellulitis. Wound cultures did not isolate MRSA from 1 of the patients with +MRSA blood cultures. 4 out of 5 patients with MRSA orbital cellulitis underwent surgical intervention on the day oftheir admission. Indications for surgery included presenting visual acuity, pupillary exam, and the presence of orbital signs including proptosis, motility restriction, and intraocular pressure.
Twenty years ago, pediatric orbital cellulitis was aclinical emergency because of H. flu and its serious neurologicsequelae. While the most common causative organisms currently stillinclude streptococcal and staphylococcal species, the increasingprevalence and severity of MRSA has once again made pediatric orbitalcellulitis an important disorder to recognize and treat.
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