Background: Periorbital (POB) and orbital cellulitis (OB) infections cause significant pediatric morbidity. We defined the clinical features and characterized the isolates of children with POB or OB caused by Staphylococcus aureus at Texas Children's Hospital (TCH), Houston, TX. Methods: Patients were identified from a prospective S. aureus study database from Jan 2002 - July 2015. Patient data was obtained from electronic medical records. Isolates were genotyped by pulsed field gel electrophoresis (PFGE) and Panton-Valentine leukocidin (pvl) genes were detected by qPCR. Data was analyzed with Fishers exact or Wilcoxon rank sum test. Results: Eighty-five patients with POB (n=58) or OB (n=27) were identified. Fifty-seven (67%) isolates were MRSA, 72 (85%) were PVL+ and 66 (78%) were USA300. No change in MRSA distribution was observed over time (2002-2015). Eleven isolates (13%) were clindamycin resistant (7 MRSA). No clinical characteristic differences were observed within each group when comparing infections caused by MRSA to MSSA or USA300 to nonUSA300 isolates. The presence of a preceding skin lesion and duration of symptoms prior to admission did not differ between POB and OB or MRSA and MSSA. Of 27 patients with OB 18 (67%) had proptosis, 20 (74%) had fever and 15 (56%) decreased extra ocular movement. All OB patients were hospitalized (mean-13.3 ±7.4 days) and received antibiotics for 18.1±6.2 days. Twelve (44%) OB patients received steroids. Steroid treatment did not affect length of hospitalization or duration of antibiotic treatment. Fifty of 57 POB patients were hospitalized for 3.8±3.4 days and received antibiotics for 10.5±2.7 days. By CT scan 18 (66%) OB and 11 (41%) POB patients had sinusitis. POB patients were more likely to be male (42/58 vs 10/27, P<0.01) and to have either no procedure performed (31, 53%) or have incision and drainage of abscesses (23, 40%), while patients with OB often required orbitotomy and/or endoscopic sinus surgery (17, 63%). Conclusion: The majority of S. aureus POB and OB infections at TCH were caused by MRSA with no change observed over time. Among MSSA, 54% were pvl+, suggesting pvl may be an important virulence factor in these presentations. S. aureus is associated with sinusitis and its complications.
K. G. Hulten, None
E. Mason Jr, None
S. L. Kaplan, Forest Labs: Grant Investigator , Research support and Site-PI for clinical trial unrelated to presented research
Pfizer: Grant Investigator , Research grant
Cubist: Grant Investigator , Research grant and Site-PI for clinical trial unrelated to presented research
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