Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia.
Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia.
Int Ophthalmol. 2023 Aug;43(8):2925-2933. doi: 10.1007/s10792-023-02698-y. Epub 2023 Apr 7.
In recent years, methicillin-resistant Staphylococcus aureus (MRSA) orbital cellulitis (OC) has drawn increasing clinical and public health concern. We present a case series of MRSA OC encountered at four Australian tertiary institutions.
A multi-centre retrospective case series investigating MRSA OC in Australia from 2013 to 2022. Patients of all ages were included.
Nine cases of culture-positive non-multi-resistant MRSA (nmMRSA) OC were identified at four tertiary institutions across Australia (7 male, 2 female). Mean age was 17.1 ± 16.7 years (range 13-days to 53-years), of which one was 13 days old, and all were immunocompetent. Eight (88.9%) patients had paranasal sinus disease, and seven (77.8%) had a subperiosteal abscess. Four (44.4%) had intracranial extension, including one (11.1%) case which was also complicated by superior sagittal sinus thrombosis. Empirical antibiotics, such as intravenous (IV) cefotaxime alone or IV ceftriaxone and flucloxacillin, were commenced. Following identification of nmMRSA, targeted therapy consisting of vancomycin and/or clindamycin was added. Nine (100%) patients underwent surgical intervention. Average hospital admission was 13.7 ± 6.9 days (range 3-25 days), with two patients requiring intensive care unit (ICU) admission due to complications related to their orbital infection. All patients had favourable prognosis, with preserved visual acuity and extraocular movements, following an average follow-up period of 4.6 months (range 2-9 months).
NMMRSA OC can follow an aggressive clinical course causing severe orbital and intracranial complications across a wide demographic. However, early recognition, initiation of targeted antibiotics and surgical intervention when required can effectively manage these complications and achieve favourable visual outcomes.
近年来，耐甲氧西林金黄色葡萄球菌（MRSA）眼眶蜂窝织炎（OC）引起了越来越多的临床和公共卫生关注。我们报告了在澳大利亚的四家三级医疗机构中遇到的一系列 MRSA OC 病例。
这是一项多中心回顾性病例系列研究，调查了 2013 年至 2022 年期间澳大利亚的 MRSA OC。纳入所有年龄段的患者。
在澳大利亚的四家三级医疗机构共发现 9 例培养阳性的非多重耐药性 MRSA（nmMRSA）OC（7 名男性，2 名女性）。平均年龄为 17.1±16.7 岁（范围为 13 天至 53 岁），其中 1 例为 13 天大，所有患者均免疫功能正常。8 例（88.9%）患者有鼻旁窦疾病，7 例（77.8%）有骨膜下脓肿。4 例（44.4%）有颅内延伸，包括 1 例（11.1%）合并上矢状窦血栓形成。开始使用经验性抗生素，如单独静脉注射（IV）头孢噻肟或 IV 头孢曲松和氟氯西林。在确定 nmMRSA 后，添加靶向治疗，包括万古霉素和/或克林霉素。9 例（100%）患者进行了手术干预。平均住院时间为 13.7±6.9 天（范围为 3-25 天），由于与眼眶感染相关的并发症，有 2 例患者需要入住重症监护病房（ICU）。所有患者在平均 4.6 个月（范围为 2-9 个月）的随访后均有良好的预后，视力和眼外运动均保留。
nmMRSA OC 可能具有侵袭性临床病程，导致广泛人群发生严重的眼眶和颅内并发症。然而，早期识别、开始针对性抗生素治疗以及在需要时进行手术干预，可以有效地治疗这些并发症并实现良好的视力结局。
