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P. I. Bokhoor, D. MIller, A. C. Schefler, T. G. Murray; Epidemiology and Microbiology of Pediatric Socket/Orbital Implant Infections Following Enucleation Secondary to Retinoblastoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1442.
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There is currently minimal data regarding socket infections in pediatric patients following enucleation secondary to retinoblastoma. The purpose of this study is to report the epidemiology and microbiology of socket infections in this population.
Review of the microbiology records of pediatric retinoblastoma patients with cultures submitted to rule out socket infections at Bascom Palmer Eye Institute from January, 2000 to June, 2007. Data on gender, age, culture positive rates, spectrum/ frequency of pathogens and in vitro susceptibility trends were recorded.
131 socket cultures were submitted from 78 patients over the 7 year study period. 48 (61.5%) of the 78 patients had an infection of whom 52% were male and 48% female. Age at presentation ranged from less than 1 year up to 17 years (mean, 4.4 years), with 85.5% of the patients presenting between the ages of 1-6 years. 111 (84.7%)of the submitted 131 cultures were positive. A single organism was isolated in 78.6% of the cultures, whereas 16.8% and 4.6% of the cultures grew two and three organisms respectively. Average number of separate positive cultures taken per patient during the study period was 2.31 and ranged from 1 to 13. Gram-negative organisms were recovered in 76.6% (85/111) of the cultures. The most frequent pathogens among this group included Haemophilus influenzae (26.1%) and Moraxella species (21.6%). Gram positive pathogens were isolated in 45.9% of the cultures. Streptococcus pneumoniae (25.2%) and Staphylococcus aureus (20.7%) were the most common gram positives. In vitro susceptibility for the most frequent pathogens was: levofloxacin, 95% (N=83), trimethoprim sulfa, 80% (N=77) and ampicillin, 42.5% (N=77). Polymyxin B provided 100% coverage for Haemophilus species.
Microbial socket infections of pediatric retinoblastoma patients post enucleation mimic those of conjunctivitis and were positive in over 60% of the cultures in this series. Retinoblastoma patients with prostheses should have their sockets routinely examined under anesthesia or in clinic and should be cultured if any discharge is present. A combination of polymyxin B and trimethoprim sulfa or topical levofloxacin alone will provide adequate coverage for these pathogens.
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