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S.R. Witherspoon, P.H. Blomquist; The Changing Microbiologic Spectrum of Preseptal and Orbital Cellulitis: Emergence of Methicillin–Resistant Staphylococcus Aureus . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3970.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the microbiologic spectrum of preseptal and orbital cellulitis in adults.
A retrospective chart review of all eyes of adult patients with a diagnosis of preseptal or orbital cellulitis seen at Parkland Memorial Hospital, the public hospital for Dallas County, between January 1999 and June 2005 was conducted.
91 patients (45 men, 46 women) were identified with infection involving the right eye in 45 cases, the left eye in 45, and bilateral in 1. The mean age was 40.6 years (range 17–70 years). Preseptal cellulitis was present in 60 patients (65.9%) and orbital cellulitis in 31 (34.1%). Cultures grew an organism in 49 cases (54%) overall, in 19 of the orbital cellulitis cases (61%), and in 30 preseptal cellulitis cases (50%). For culture–positive orbital cellulitis cases, 17 (89%) grew gram positive organisms, 4 (21%) grew gram negatives, and 1 (5%) grew Fusarium. Staphlyococcus aureus was present in 5 (26%) of the culture positive orbital cellulitis cases, and 80% of the S. aureus isolates were methicillin–resistant. For preseptal cellulitis, gram positives were present in 27 (90%) of culture–positive cases, gram negatives in 3 (10%), and fungi in 3 (10%). S. aureus was cultured in 20 (67%) of the culture–positive preseptal cellulitis cases, and 18 (90%) of those isolates were methicillin–resistant. 43 (47%)of the 91 patients with orbital or preseptal cellulitis had sinus disease, 7 (8%) had previous orbital trauma, 4 (4%) had extension of dental disease, 2 (2%) had an ocular prosthesis, and 2 (2%) had recent orbital surgery.
Methicillin–resistant S. aureus (MRSA) infections are a growing problem in the greater Dallas area. Initial treatment of preseptal and orbital cellulitis may need to be modified to reflect the high likelihood of MRSA as an etiology.
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