Microbiology of pediatric orbital cellulitis.
OBJECTIVE
To evaluate the microbiology of pediatric orbital cellulitis associated with sinusitis.


METHODS
Retrospective review of medical records of pediatric patients treated for orbital cellulitis.


METHODS
All pediatric patients treated for orbital cellulitis associated with sinusitis at Texas Children's Hospital between December 1, 2001 and September 30, 2005 were reviewed. Data collected included patient age, history, microbiology results, and surgical intervention.


RESULTS
Thirty-eight cases were identified. Fifteen cases required medical management, whereas 23 patients received a combination of medical and surgical intervention. Three patients had multiple surgical procedures performed. Of the procedures performed, four were sinus irrigation, 12 were sinusotomy and drainage, nine were orbitotomy with drainage of abscess, and one was craniotomy with drainage of abscess. Surgical aspirate specimens yielded a higher positive culture result rate with 9/9 of orbital abscesses and 13/16 of sinus aspirates demonstrating a positive yield. Two of the 27 blood cultures had a positive yield. Staphylococcus species was the most common organism isolated. Methicillin-resistant S. aureus (MRSA) represented 73% of S. aureus isolates. Streptococcus species was the next most common pathogen. Three cultures yielded Haemophilus species with one being positive for H. influenzae.


CONCLUSIONS
Organisms responsible for causing pediatric orbital cellulitis are evolving, with Staphylococcus followed by Streptococcus species being the most common pathogens. The occurrence of MRSA in pediatric orbital cellulitis is increasing, and empiric antimicrobial therapy should be directed against these organisms if they are prevalent in the community. Sinus and orbital abscess aspirates yielded the greatest number of positive cultures, though these invasive surgical procedures should be performed only when clinically indicated.
McKinley
Steven H
SH
Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
Yen
Michael T
MT
Miller
Aaron M
AM
Yen
Kimberly G
KG
D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D002481:Cellulitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015818:Eye Infections, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D013508:Ophthalmologic Surgical Procedures; D009916:Orbital Diseases / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D012852:Sinusitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy
D000900:Anti-Bacterial Agents