Rocky Mountain Lions Eye Institute, University of Colorado, Denver, Colorado, USA.
Ophthalmology. 2012 Jun;119(6):1238-43. doi: 10.1016/j.ophtha.2012.01.010. Epub 2012 Mar 9.
To evaluate the epidemiologic and clinical features of orbital cellulitis caused by methicillin-resistant Staphylococcus aureus (MRSA).
Multicenter, retrospective case series.
Fifteen patients with culture-positive MRSA orbital cellulitis.
All recent cases of orbital cellulitis at several hospitals and surgical centers were reviewed, and cases with culture-positive MRSA from aspirates were identified. The data collected and analyzed retrospectively included patient demographics, medical history, presenting sign, imaging results, surgical procedure performed, surgical culture results, visual acuity at presentation and last follow-up, and duration of antibiotics.
Presenting sign, radiographic evidence of paranasal sinus disease, radiographic evidence of multiple orbital abscesses, presence or absence of antecedent upper respiratory infection, and final visual acuity.
Fifteen cases were identified. The mean patient age was 31.9 years (standard deviation, 24.2 years). Lid swelling was the presenting sign in 14 of 15 patients. No patients had a preceding upper respiratory infection, and only 1 patient had antecedent eyelid trauma. Only 3 of 15 patients had documented adjacent paranasal sinus disease on imaging. Lacrimal gland abscess or dacryoadenitis was the presenting finding in 5 of 15 patients. Multiple orbital abscesses were identified in 4 of 15 patients by computed tomography or magnetic resonance imaging. Fourteen of 15 cases required surgical intervention. Four of 15 cases had loss of visual acuity to light perception or worse. All 4 of these cases had a delay in referral for surgical intervention.
In these 15 patients with MRSA orbital cellulitis, the typical clinical setting of orbital cellulitis was absent; chiefly, there was no identified antecedent upper respiratory illness, nor was there a preceding traumatic injury. Lid swelling in the absence of recent upper respiratory illness, lacrimal gland focus, multiple orbital abscesses, and lack of adjacent paranasal sinus disease may be predictive factors that suggest MRSA as the causative organism of orbital cellulitis.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
评估耐甲氧西林金黄色葡萄球菌（MRSA）引起的眶蜂窝织炎的流行病学和临床特征。
多中心回顾性病例系列。
15 例培养阳性 MRSA 眶蜂窝织炎患者。
回顾了几家医院和外科中心最近的所有眶蜂窝织炎病例，并确定了从抽吸物中培养出阳性 MRSA 的病例。回顾性收集和分析的数据包括患者人口统计学资料、病史、就诊体征、影像学结果、实施的手术程序、手术培养结果、就诊时和最后随访时的视力以及抗生素使用时间。
就诊体征、副鼻窦疾病的影像学证据、多个眼眶脓肿的影像学证据、是否存在上呼吸道感染前驱史以及最终视力。
共发现 15 例病例。患者平均年龄为 31.9 岁（标准差 24.2 岁）。15 例患者中有 14 例以眼睑肿胀为首发体征。无患者有上呼吸道感染前驱史，仅有 1 例患者有眼睑外伤前驱史。影像学检查仅发现 3 例患者有相邻副鼻窦疾病。15 例患者中有 5 例以泪腺脓肿或泪腺炎为首发表现。15 例患者中有 4 例通过计算机断层扫描或磁共振成像检查发现多个眼眶脓肿。15 例患者中有 14 例需要手术干预。15 例患者中有 4 例视力丧失至光感或更差。这 4 例均因手术干预延迟而导致视力丧失。
在这 15 例 MRSA 眶蜂窝织炎患者中，典型的眶蜂窝织炎临床环境缺失，主要是没有明确的上呼吸道感染前驱史，也没有外伤史。无近期上呼吸道感染史的眼睑肿胀、泪腺病灶、多个眼眶脓肿和缺乏相邻副鼻窦疾病可能是提示 MRSA 为眶蜂窝织炎致病病原体的预测因素。
作者在本文讨论的材料中没有任何专有的或商业的利益。
