title: Orbital complications of acute sinusitis: changes in the post-pneumococcal vaccine era.
abstract: OBJECTIVE
  The widespread use of the 7-valent pneumococcal conjugate vaccine (PVC7), developed to combat invasive Streptococcus pneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from acute sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to acute sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management.
  
  
  OBJECTIVE
  To determine if the characteristics of orbital complications from acute sinusitis in children have changed in the post-PCV7 era.
  
  
  METHODS
  Review of clinical data.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups.
  
  
  METHODS
  Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups.
  
  
  RESULTS
  A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans -positive sinus or blood cultures were observed (22.4% vs 0% [P < .001] and 12.24% vs 0% [P = .005], respectively). An increase in Staphylococcus aureus was seen in the post-PCV7 group (20.4% vs 42.37% [P = .02]). Methicillin-resistant S aureus (MRSA) was isolated only in the post-PCV7 group (P = .002). The pre-PCV7 group had a significantly longer hospital stay than the post-PCV7 group (7.15 days vs 5.47 days [P = .004]).
  
  
  CONCLUSIONS
  Although universal PCV7 vaccination has eliminated S pneumoniae as an etiologic pathogen in acute sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to acute sinusitis.
authors: Division of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, Washington, DC 20010, USA. mpena@cnmc.org
authors: Maria T
authors: MT
authors: Peña
authors: Diego
authors: D
authors: Preciado
authors: Michael
authors: M
authors: Orestes
authors: Sukgi
authors: S
authors: Choi
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000382:microbiology* / Q000628:therapy; D000208:Acute Disease; D002481:Cellulitis / Q000209:etiology* / Q000382:microbiology* / Q000628:therapy; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009916:Orbital Diseases / Q000209:etiology* / Q000382:microbiology* / Q000628:therapy; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications* / Q000382:microbiology* / Q000628:therapy
chemical_list: D022242:Pneumococcal Vaccines