Characteristics of Orbital Cellulitis in Cancer Patients and Diabetics

Abstract

Purpose : Orbital cellulitis (OC) is a life-threatening infection requiring prompt diagnosis for proper management. Understanding its management upon diagnosis is essential for those treating OC, especially for patients with weakened immune systems. This study aims to elucidate how OC management is affected by preexisting cancer and diabetes mellitus (DM) diagnoses at Johns Hopkins.

Methods : We conducted a retrospective cohort study of adult patients who underwent treatment for OC at Johns Hopkins from 2007 to 2022. Fisher’s exact and general linear model tests were used to compare demographics, admission and diagnostic characteristics, antibiotic use and surgery, and readmissions between patients with and without preexisting cancer or DM diagnoses.

Results : Of 162 patients who were included, 38 had cancer and 47 had DM. A significantly higher proportion of cancer patients identified as white compared to the non-cancer cohort (76.3% vs. 50.8%, p=0.015). Both cohorts mostly presented to the ED (60.5% cancer patients, 71.8% non-cancer patients). More patients with cancer had ophthalmology consults at presentation (92.1% vs. 68.6%, p=0.003). Approximately, CT scan was obtained in 80% of cases, 80% of all scans confirmed OC and 50% indicated preseptal cellulitis. Though not statistically significant, cancer patients had a longer course of IV antibiotics and length of stay compared to non-cancer patients. Fewer patients with cancer were prescribed antibiotics at discharge.
Demographic characteristics and presentation location were similar for patients with and without DM. Patients with DM had higher rates of hospital admission (78.7% vs. 63.5%, p=0.038) and ophthalmology consult at presentation (85.1% vs. 70.0%, p=0.048). The cohorts had similar CT scan results, laterality, etiology, and surgery rates. Patients with DM had a longer duration of IV antibiotic use (8.0 vs. 4.6 days, p=0.001), a longer length of stay (7.0 vs. 4.1 days, p=0.014), and higher readmission rates (26.1% vs. 9.6%, p=0.011).

Conclusions : Adults with OC and preexisting cancer or DM diagnoses have longer lengths of stay and IV antibiotics duration, and a higher rate of ophthalmology consult at presentation compared to non-cancer or non-diabetic patients. Patients with DM have a higher risk of hospital admission and readmission compared to non-diabetics.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

OC treatment characteristics in patients with and without cancer (table 1), or DM (table 2). *p<0.05
Table 1

 

Table 2