Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland.
Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
J AAPOS. 2023 Aug;27(4):200.e1-200.e6. doi: 10.1016/j.jaapos.2023.05.010. Epub 2023 Jul 22.
To determine the prevalence and types of pathogens found in children with orbital cellulitis and to evaluate the utility of nonoperative cultures.
This was a retrospective cohort study of children with imaging-confirmed orbital cellulitis over a period of 8 years. Outcomes included prevalence and types of organisms, polymicrobial infection, mixed aerobic-anaerobic infection, effect of age, and culture utility.
Of 220 children with orbital cellulitis, 112 (51%) had cultures taken; 69 (31%) had surgical intervention. Culture sources for the 112 children with cultures included blood (57 patients [51%]), sinus (53 [47%]), orbit (42 [38%]), brain (6 [5%]), and skin/conjunctiva/lacrimal sac (6 [5%]). Streptococcus anginosus group strains grew in cultures from 19 children (17%); methicillin-sensitive Staphylococcus aureus (MSSA), in 15 (13%); Streptococcus pyogenes, in 12 (11%); methicillin-resistant Staphylococcus aureus (MRSA), in 6 (5%); anaerobic/facultative gram negative rods, in 8 (7%); anaerobic Gram-positive cocci, other Viridans group streptococci, and Streptococci pneumoniae, in 3 (3%) each; and normal respiratory/skin flora, in 23 (21%). Polymicrobial infection (P = 0.08) and anaerobic organisms (P = 0.58) did not differ by age (range, 0.1-16.8 years). In all 220 (100%) children, nonoperative cultures were either not obtained (108 [49%]), not helpful in avoiding surgery (69 [31%]), showed no growth (39 [18%]), or grew an organism that did not change management from empiric therapy (4 [2%]).
While many organisms may be cultured from children with orbital cellulitis, Streptococcus and MSSA were the most common in our study cohort. MRSA is uncommon, so initial empiric coverage is not necessary. Rates of polymicrobial and anaerobic infection were similar across ages. Our results indicate that nonoperative cultures are not indicated in the initial medical management of orbital cellulitis; in our cohort, they neither resulted in treatment changes nor helped avoid surgery.
确定患有眶蜂窝织炎的儿童中发现的病原体的流行率和类型，并评估非手术培养的效用。
这是一项为期 8 年的影像学证实的眶蜂窝织炎患儿回顾性队列研究。结果包括病原体的流行率和类型、混合需氧-厌氧感染、年龄的影响以及培养的效用。
在 220 例眶蜂窝织炎患儿中，112 例（51%）进行了培养；69 例（31%）进行了手术干预。112 例有培养物的患儿的培养物来源包括血液（57 例[51%]）、窦（53 例[47%]）、眶（42 例[38%]）、脑（6 例[5%]）和皮肤/结膜/泪囊（6 例[5%]）。19 例患儿的培养物中生长出咽峡链球菌群菌株（17%）；15 例患儿（13%）为甲氧西林敏感金黄色葡萄球菌（MSSA）；12 例患儿（11%）为化脓性链球菌；6 例患儿（5%）为耐甲氧西林金黄色葡萄球菌（MRSA）；8 例患儿（7%）为需氧/兼性革兰阴性杆菌；3 例患儿（3%）分别为厌氧革兰阳性球菌、其他草绿色链球菌和肺炎链球菌；23 例患儿（21%）为正常呼吸道/皮肤菌群。年龄（范围为 0.1-16.8 岁）对多微生物感染（P=0.08）和厌氧生物（P=0.58）没有影响。在所有 220 例（100%）患儿中，非手术培养物要么未获得（108 例[49%]），要么对避免手术没有帮助（69 例[31%]），要么没有生长（39 例[18%]），要么培养出的微生物与经验性治疗相比不会改变治疗（4 例[2%]）。
虽然眶蜂窝织炎患儿可能培养出多种微生物，但在我们的研究队列中，链球菌和 MSSA 最为常见。MRSA 并不常见，因此初始经验性治疗无需覆盖此类病原体。多微生物和厌氧感染的发生率在不同年龄组相似。我们的结果表明，非手术培养物在眶蜂窝织炎的初始药物治疗中并不适用；在我们的队列中，它们既没有导致治疗方案的改变，也没有帮助避免手术。
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