Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston.
Department of Head and Neck Surgery, M.D. Anderson Cancer Center, Houston, Texas.
J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):205-209. doi: 10.1093/jpids/pix036.
Periorbital and orbital cellulitis cause significant pediatric morbidity. Here, we define the clinical features of and characterize isolates from children with periorbital or orbital cellulitis caused by Staphylococcus aureus at Texas Children's Hospital in Houston.
Patients were identified from a prospective S aureus study database from January 2002 to July 2015. Demographic and clinical data were collected retrospectively. Isolates were genotyped by pulsed-field gel electrophoresis, and Panton-Valentine leukocidin (lukSF-PV [pvl]) genes were detected by quantitative polymerase chain reaction. Data were analyzed with the Fisher exact or Wilcoxon rank-sum test.
Eighty-five patients with periorbital (n = 58) or orbital (n = 27) cellulitis were identified. We found 57 (67%) methicillin-resistant S aureus (MRSA) isolates, 72 (85%) pvl-positive (pvl+) isolates, and 66 (78%) USA300 isolates. No differences in clinical characteristics were found when we compared MRSA to methicillin-susceptible (MSSA) infections or USA300 to non-USA300 infections. Patients with orbital cellulitis were hospitalized a median of 12 days (range, 2-28 days) and received antibiotics for 21 days (range, 10-32 days). Twelve (44%) patients with orbital cellulitis received steroids. Steroid treatment did not affect the length of hospitalization or duration of antibiotic treatment. Six (7%) patients with orbital cellulitis were bacteremic. Patients with periorbital cellulitis were hospitalized for a median of 3 days (range, 0-17 days) and received antibiotics for 11 days (range, 7-32 days). According to computed tomography (CT), 19 (70%) patients with orbital cellulitis and 11 (41%) with periorbital cellulitis had sinusitis.
The majority of periorbital and orbital S aureus infections at Texas Children's Hospital were caused by MRSA, and no change was observed over time. Empirical antibiotic treatment should include coverage for MRSA. PVL might be an important virulence factor in these presentations. S aureus is associated with sinusitis and its complications.
眶周和眼眶蜂窝织炎可导致儿童出现严重的疾病。在此，我们对休斯顿德克萨斯儿童医疗中心由金黄色葡萄球菌引起的眶周或眼眶蜂窝织炎患儿的临床特征和分离株进行了定义。
我们从 2002 年 1 月至 2015 年 7 月的一项金黄色葡萄球菌前瞻性研究数据库中确定了患者。我们回顾性收集了人口统计学和临床数据。通过脉冲场凝胶电泳对分离株进行基因分型，并通过实时聚合酶链反应检测杀白细胞素（lukSF-PV[pvl]）基因。采用 Fisher 确切检验或 Wilcoxon 秩和检验进行数据分析。
共鉴定出 85 例眶周（n=58）或眼眶（n=27）蜂窝织炎患儿。我们发现 57 例（67%）耐甲氧西林金黄色葡萄球菌（MRSA）分离株、72 例（85%）pvl 阳性（pvl+）分离株和 66 例（78%）USA300 分离株。MRSA 与甲氧西林敏感金黄色葡萄球菌（MSSA）感染或 USA300 与非 USA300 感染比较，临床特征无差异。眼眶蜂窝织炎患儿的中位住院时间为 12 天（范围：2-28 天），抗生素治疗时间为 21 天（范围：10-32 天）。12 例（44%）眼眶蜂窝织炎患儿接受了类固醇治疗。类固醇治疗并未影响住院时间或抗生素治疗时间。6 例（7%）眼眶蜂窝织炎患儿菌血症。眶周蜂窝织炎患儿的中位住院时间为 3 天（范围：0-17 天），抗生素治疗时间为 11 天（范围：7-32 天）。根据计算机断层扫描（CT），19 例（70%）眼眶蜂窝织炎患儿和 11 例（41%）眶周蜂窝织炎患儿有鼻窦炎。
德克萨斯儿童医疗中心的大部分眶周和眼眶金黄色葡萄球菌感染是由 MRSA 引起的，且随时间无变化。经验性抗生素治疗应包括对 MRSA 的覆盖。PVL 可能是这些表现的一个重要毒力因子。金黄色葡萄球菌与鼻窦炎及其并发症有关。
