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Chew WCD, Kwek JWM, Anicete R, Low MY. Pediatric orbital cellulitis: Case report of an unusual etiology and pathogen. EAR, NOSE & THROAT JOURNAL 2024; 103:559-564. [PMID: 35023786 DOI: 10.1177/01455613211064002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Orbital cellulitis is an uncommon condition with risks to sight and life. As a complication of maxillofacial injuries, the literature suggests this is only possible with fractures or direct inoculation, and there are no reports to the contrary. Here, we make the first report of a possible etiology by which orbital cellulitis developed in a 14-year-old boy even without skin breach or bony fractures; as well as a rare causative pathogen. He presented with facial abscess and progressive orbital cellulitis after blunt facial trauma, requiring functional endoscopic sinus surgery with needle aspiration of facial abscess externally. Cultures showed growth of Streptococcus constellatus/Parvimonas micra, and he received further antibiotics with full recovery.The pathophysiology of orbital cellulitis in this patient is attributed to vascular congestion and local pressure from maxillofacial contusion and maxillary hemoantrum, with impaired paranasal sinus ventilation encouraging anaerobic bacterial growth. Further progression led to facial abscess formation and intraorbital spread with orbital cellulitis. The pediatric demographic is injury-prone, and self-reporting of symptoms can be delayed. Hence, increased suspicion of complicated injuries and orbital cellulitis may be required when managing maxillofacial contusions so that prompt treatment can be given.
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Affiliation(s)
- Wen Chao Daniel Chew
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - James Wei Ming Kwek
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Rosslyn Anicete
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mei-Yi Low
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
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2
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André C, Lebreton F, Van Tyne D, Cadorette J, Boody R, Gilmore MS, Bispo PJM. Microbiology of Eye Infections at the Massachusetts Eye and Ear: An 8-Year Retrospective Review Combined With Genomic Epidemiology. Am J Ophthalmol 2023; 255:43-56. [PMID: 37343741 PMCID: PMC10592486 DOI: 10.1016/j.ajo.2023.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/28/2023] [Accepted: 06/16/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Ocular bacterial infections are important causes of morbidity and vision loss. Early antimicrobial therapy is necessary to save vision, but their efficacy is increasingly compromised by antimicrobial resistance (AMR). We assessed the etiology of ocular bacterial infections seen at Massachusetts Eye and Ear and investigated the molecular epidemiology and AMR profiles of contemporary isolates. DESIGN Laboratory investigation. METHODS We used a combination of phenotypic tests and genome sequencing to identify the predominant lineages of leading ocular pathogens and their AMR profiles. RESULTS A total of 1601 isolates were collected from 2014 to 2021, with Staphylococcus aureus (n = 621), coagulase-negative staphylococci (CoNS) (n = 234), Pseudomonas aeruginosa (n = 213), Enterobacteriaceae (n = 167), and Streptococcus pneumoniae (n = 95) being the most common. Resistance was high among staphylococci, with methicillin resistance (MR) detected in 28% of S aureus and 39.8% of CoNS isolates. Multidrug resistance (MDR) was frequent among MR staphylococci (MRSA 60%, MRCoNS 76.1%). The population of S aureus isolates consisted mainly of 2 clonal complexes (CCs): CC8 (26.1%) and CC5 (24.1%). CC5 strains carried a variety of AMR markers, resulting in high levels of resistance to first-line therapies. Similarly, the population of ocular Staphylococcus epidermidis was homogenous with most belonging to CC2 (85%), which were commonly MDR (48%). Conversely, ocular S pneumoniae, P aeruginosa, and Enterobacteriaceae were often susceptible to first-line therapies and grouped into highly diverse genetic populations. CONCLUSION Our data showed that ocular bacterial infections in our patient population are disproportionately caused by strains that are resistant to clinically relevant antibiotics and are associated with major epidemic genotypes with both community and hospital associations.
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Affiliation(s)
- Camille André
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary
| | - François Lebreton
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary; Department of Microbiology and Immunology (F.L., D.V., M.S.G.), Harvard Medical School, Boston, Massachusetts, USA
| | - Daria Van Tyne
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary; Department of Microbiology and Immunology (F.L., D.V., M.S.G.), Harvard Medical School, Boston, Massachusetts, USA
| | - James Cadorette
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary
| | - Rick Boody
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary
| | - Michael S Gilmore
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary; Department of Microbiology and Immunology (F.L., D.V., M.S.G.), Harvard Medical School, Boston, Massachusetts, USA
| | - Paulo J M Bispo
- From the Department of Ophthalmology (C.A., F.L., D.V., J.C., R.B., M.S.G., P.J.M.B.), Massachusetts Eye and Ear Infirmary.
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3
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Reed W, Okafor S, Cheng J. Pediatric COVID-19 associated acute rhinosinusitis and periorbital abscess: A case report. OTOLARYNGOLOGY CASE REPORTS 2022; 24:100461. [PMID: 35813303 PMCID: PMC9252921 DOI: 10.1016/j.xocr.2022.100461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Complications of acute rhinosinusitis(ARS) in the pediatric population can include intra- and extracranial involvement from spread of infection. Though these infections are most commonly preceded by a URI, infection with Sars-CoV-2 (COVID-19) as the inciting event for complicated ARS has rarely been described in the pediatric population. Furthermore, decision making surrounding surgical management of acutely infected patients with COVID-19 remains complicated. This case demonstrates complicated ARS in an otherwise healthy 10-year-old patient with an orbital abscess following COVID-19 infection, ultimately requiring both internal and external surgical approaches for adequate management.
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Selected Disorders of the Eye. Fam Med 2022. [DOI: 10.1007/978-1-4939-0779-3_134-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Selected Disorders of the Eye. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Gill PJ, Mahant S, Hall M, Parkin PC, Shah SS, Wolter NE, Mestre M, Markham JL. Association Between Corticosteroids and Outcomes in Children Hospitalized With Orbital Cellulitis. Hosp Pediatr 2022; 12:70-89. [PMID: 34877598 DOI: 10.1542/hpeds.2021-005910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To examine the association between systemic corticosteroid use and outcomes for children hospitalized with orbital cellulitis at US children's hospitals. METHODS We conducted a multicenter observational study using administrative data from the Pediatric Health Information System database from 2007 to 2019. Children between the ages of 2 months and 18 years with International Classification of Diseases, Ninth Revision, Clinical Modification or 10th Revision, Clinical Modification discharge diagnostic codes of orbital cellulitis were included. The primary exposure was receipt of systemic corticosteroids on the day of hospital admission. The primary outcome was hospital length of stay, and secondary outcomes included surgical intervention, ICU admissions, revisits, and health care costs. We used generalized logit model with inverse probability weighting logistic regression to adjust for demographic factors and assess for differences in clinical outcomes reported. RESULTS Of the 5832 patients hospitalized with orbital cellulitis, 330 (5.7%) were in the corticosteroid group and 5502 (94.3%) were in the noncorticosteroid group. Patients in the corticosteroid group were older, had more severe illness, and received broad spectrum antibiotics. In adjusted analyses, corticosteroid exposure was not associated with differences in length of hospital stay, need for surgical intervention, ICU admissions, emergency department revisits, 30-day hospital readmissions, or hospital costs. Restricting the analysis to only those patients who received broad spectrum antibiotics did not change the findings. CONCLUSIONS Early use of systemic corticosteroids in hospitalized children with orbital cellulitis is not associated with improved clinical outcomes. Use of corticosteroids in hospitalized children with orbital cellulitis should be discouraged outside of clinical trials.
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Affiliation(s)
- Peter J Gill
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation.,Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine.,Institute of Health Policy, Management and Evaluation.,Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Patricia C Parkin
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine.,Hospital for Sick Children, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nikolaus E Wolter
- Department of Otolaryngology, Head & Neck Surgery, The University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
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Martins M, Martins SP, Pinto-Moura C, Leal V, Spratley J. Management of post-septal complications of acute rhinosinusitis in children: A 14-year experience in a tertiary hospital. Int J Pediatr Otorhinolaryngol 2021; 151:110925. [PMID: 34597875 DOI: 10.1016/j.ijporl.2021.110925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/17/2021] [Accepted: 09/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Acute rhinosinusitis accounts for most of the cases of orbital infections and is the most common cause of periorbital oedema in children. Up to 10% of patients with orbital complications of acute rhinosinusitis may experience vision loss and other complications such as meningitis, intracranial abscess or even death. Therefore, these patients require prompt diagnosis and proper treatment. OBJECTIVES This study aims to report the clinical presentation and management of post-septal orbital complications of acute rhinosinusitis in the paediatric population. MATERIALS AND METHODS A retrospective medical chart review of all children aged under 18 years old who were diagnosed with post-septal orbital complications of acute rhinosinusitis at a tertiary academic hospital, between 01/2007 and 12/2020. Patients were grouped according to the Chandler Classification (groups 2-5). RESULTS Fifty-five children (mean age of 6.91 ± 4.61 years) fulfilled the entry criteria for post-septal orbital complications of acute rhinosinusitis, based on clinical evaluation by an otorhinolaryngologist and CT-scan findings. Forty (72.72%) patients were also evaluated by an ophthalmologist. Most patients were male (76.36%). Twenty-four patients had post-septal cellulitis (43.63%), 21 patients had a subperiosteal abscess (38.18%) and 10 patients had an orbital abscess (18.18%). Eyelid swelling was the most frequent sign, followed by fever. Microbiology varied considerably and gram-positive agents were clearly predominant. Eighteen (32.73%) patients had been treated with oral antibiotics prior to hospital admission, exhibiting a significantly higher risk of recurrence of orbital infection (p = 0.020). Ethmoid and maxillary sinuses were the most involved paranasal sinuses (90.91%). Thirty-three patients (60%) were successfully treated medically, and 22 patients (40%) required surgical drainage. Seven patients (12.73%) developed further complications and six recovered without sequelae. The mean length of hospital stay was 8.0 ± 5.0 days and recurrence of orbital infection occurred in six patients (10.91%). The absolute neutrophil blood count was significantly different amongst Chandler groups (p = 0.021), with higher counts in patients with subperiosteal abscess. The duration of hospitalization was significantly higher in patients submitted to surgery (p < 0.001). CONCLUSION Post-septal orbital complications of acute rhinosinusitis are infrequent but dangerous events in the paediatric population. Close collaboration with Ophtalmology is paramount, as the child's vision is at risk. Eyelid swelling and proptosis are early signs. CT-scan imaging plays an invaluable role in the diagnosis and decision-making. Predictive indicators for surgery were not found. However, emergency endoscopic nasal surgery with abscess drainage should be considered whenever vision is at risk, if there is no improvement after aggressive medical treatment, and in cases of intracranial complications.
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Affiliation(s)
- Manuel Martins
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal.
| | - Sónia Pires Martins
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal; Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal.
| | - Carla Pinto-Moura
- Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal; Department of Genetics, University Hospital S. João Centre, Faculty of Medicine of University of Oporto, Portugal; I3S, Institute Research and Innovation Health, University of Oporto, Portugal.
| | - Vitor Leal
- Department of Ophtalmology, University Hospital S. João Centre, E.P.E., Porto, Portugal.
| | - Jorge Spratley
- Unit of Otorhinolaryngology, Department of Surgery & Physiology, University of Porto Faculty of Medicine, Porto, Portugal; Department of Otorhinolaryngology, University Hospital S. João Centre, E.P.E., Porto, Portugal; Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal.
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8
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Abstract
BACKGROUND Preseptal and orbital cellulitis are two types of infection surrounding the orbital septum with very different potential outcomes. Our aim was to describe key differential features of both conditions, laying special emphasis on diagnostic and therapeutic tools. METHODS A retrospective review of patients admitted to a tertiary hospital over a 15-year period (January 2004-October 2019) was conducted. We included 198 patients with preseptal and 45 with orbital cellulitis. Descriptive statistics were performed to examine the available information. RESULTS Statistically significant differences were found between patients with preseptal and orbital cellulitis regarding age (3.9 ± 2.14 vs. 7.5 ± 4.24 years), presence of fever (51.5% vs. 82.2%), and preexisting sinusitis (2% vs. 77.8%) (all P < 0.001). Diplopia, ophthalmoplegia and proptosis were only present in orbital cellulitis (P < 0.001). Median values of C-reactive protein were significantly higher among children with orbital involvement [136.35 mg/L (IQR 74.08-168.98) vs. 17.85 (IQR 6.33-50.10), P < 0.0001]. A CRP>120 mg/L cut-off point for orbital cellulitis was obtained. Early CT scans were performed in 75.6% of suspected orbital cellulitis and helped detecting complications at an early stage. Abscesses were revealed in 70.6% of cases, especially medial subperiosteal abscesses (58.8%). All patients received intravenous antibiotics, whereas corticosteroids were preferred in patients with orbital implication (8.6% vs. 73.3%, P < 0.001). Only 26.7% of patients required additional surgery. CONCLUSIONS Clinical presentation and CRP are extremely sensitive for differential diagnosis of preseptal and orbital cellulitis. Prompt initiation of intravenous antibiotics is mandatory and can prevent surgical procedures even in cases with incipient abscesses.
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9
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Akoh CC, Akintilo L, Shankar S, Lo Sicco K. A rare case of microblading-induced preseptal cellulitis. JAAD Case Rep 2021; 16:98-100. [PMID: 34553011 PMCID: PMC8441103 DOI: 10.1016/j.jdcr.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Christine C Akoh
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Lisa Akintilo
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Shruthi Shankar
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Kristen Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
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10
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Murphy DC, Meghji S, Alfiky M, Bath AP. Paediatric periorbital cellulitis: A 10-year retrospective case series review. J Paediatr Child Health 2021; 57:227-233. [PMID: 32987452 DOI: 10.1111/jpc.15179] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
AIM To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis. METHODS Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10-year period. Regression investigated correlations for continuous and categorical variables. RESULTS A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10-year period. Of these, 139 had pre-septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month-17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross-sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C-reactive protein was associated with greater risk of post-septal disease and requiring surgery. The best predictors of post-septal disease in the multivariate analysis (R2 = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R2 = 0.53, P = <0.001). CONCLUSION Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life-threatening or sight-threatening complications.
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Affiliation(s)
- Declan C Murphy
- Ear, Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northumbria Specialist Emergency Care Hospital, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Sheneen Meghji
- Ear, Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Mohamed Alfiky
- Ear, Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Ear, Nose and Throat Department, Queen Elizabeth Hospital, Ear, King's Lynn, United Kingdom
| | - Andrew P Bath
- Ear, Nose and Throat Department, Norfolk and Norwich University Hospital, Norwich, United Kingdom
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11
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Cost comparison between surgical and conservative management for pediatric sinogenic subperiosteal abscesses. Int J Pediatr Otorhinolaryngol 2021; 140:110542. [PMID: 33302023 DOI: 10.1016/j.ijporl.2020.110542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND There remains variation in management of orbital complications of acute bacterial rhinosinusitis (ABRS); specifically, those subperiosteal abscesses that present without immediate surgical indication. Recent systematic reviews on management and proposed treatment algorithms are helpful but do not consider the financial implications for healthcare systems and patients. METHODS A retrospective chart review of pediatric patients from a tertiary care children's hospital between 2002 and 2020 was performed, identifying patients via ICD coding corresponding to acute bacterial sinusitis and orbital involvement classified as Chandler 3 confirmed by contrasted computed tomography (CT). Two groups of patients were identified: intravenous (IV) antibiotics alone and IV antibiotics plus surgery. Billing records of total hospital charges and physician fees were recorded for financial analysis. Demographic, length of stay, and charges were analyzed. RESULTS 58 patients with ABRS and Chandler 3 orbital involvement were confirmed by CT imaging. Twenty-nine (50%) were treated with IV antibiotics alone, and twenty-nine (50%) underwent surgery in addition to IV antibiotics. There were no significant differences in patient demographics. The average total hospital charges for the medically managed group were $9262 ± 4831 compared to $30,830 ± 11,397 for the surgical group (p < 0.0001). In the medically managed group, the average hospital fees were $7305 ± 4048 and the average physician fees were $1543 ± 799. In the surgical group, the average hospital and physician fees were also significantly higher at $23,071 ± 7305 (p < 0.0001) and $7763 ± 3335 (p < 0.0001), respectively. Patients who were treated medically and had a longer than average LOS still had significantly fewer charges than those treated with antibiotics plus surgery and a shorter than average length of stay [$15,311 and $27,723, respectively (p = 0.02)]. CONCLUSION Pediatric ABRS with orbital involvement requires prompt attention and management. Controversy persists over subperiosteal abscess management that present without overt surgical indications. Surgical intervention is expensive. Our subgroup analysis demonstrates the magnitude of this cost difference. Specifically, longer inpatient stays with IV antibiotics alone appear to be significantly cheaper than shorter ones that include surgery. Not all Chandler 3 patients are candidates for non-surgical management; however, clinicians are encouraged to keep these data in mind for those patients where further medical management is safe and may yield less expensive clinical resolution.
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12
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Selected Disorders of the Eye. Fam Med 2020. [DOI: 10.1007/978-1-4939-0779-3_134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Gill PJ, Parkin PC, Begum N, Drouin O, Foulds J, Pound C, Quet J, Vomiero G, Wahi G, Sakran M, Kozlowski N, Bayliss A, Kanani R, Sehgal A, Pullenayegum EM, Reginald A, Wolter N, Mahant S. Care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis: protocol for a multicentre, retrospective cohort study. BMJ Open 2019; 9:e035206. [PMID: 31871262 PMCID: PMC6937073 DOI: 10.1136/bmjopen-2019-035206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Skin and soft tissue infections of the eye can be classified based on anatomic location as either anterior to the orbital septum (ie, periorbital cellulitis) or posterior to the orbital septum (ie, orbital cellulitis). These two conditions are often considered together in hospitalised children as clinical differentiation is difficult, especially in young children. Prior studies have identified variation in management of hospitalised children with orbital cellulitis; however, they have been limited either as single centre studies or by the use of administrative data which lacks clinical details important for interpreting variation in care. We aim to describe the care and outcomes of Canadian children hospitalised with periorbital and orbital cellulitis. METHOD AND ANALYSIS This is a multisite retrospective cohort study including previously healthy children aged 2 months to 18 years admitted to hospital with periorbital or orbital cellulitis from 2009 to 2018. Clinical data from medical records from multiple Canadian hospitals will be collected, including community and academic centres. Demographic characteristics and study outcomes will be summarised using descriptive statistics, including diagnostic testing, antibiotic therapy, adjunctive therapy, surgical intervention and clinical outcomes. Variation will be described and evaluated using χ² test or Kruskal-Wallis test. Generalised linear mixed models will be used to identify predictors of surgical intervention and longer length of stay. ETHICS AND DISSEMINATION Approval of the study by the Research Ethics Board at each participating site has been obtained prior to data extraction. Study results will be disseminated by presentations at national and international meetings and by publications in high impact open access journals. By identifying important differences in management and outcomes by each hospital, the results will identify areas where care can be improved, practice standardised, unnecessary diagnostic imaging reduced, pharmacotherapy rationalised and where trials are needed.
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Affiliation(s)
- Peter J Gill
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nurshad Begum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Olivier Drouin
- Department of Pediatrics, University of Montreal, Montreal, Québec, Canada
| | - Jessica Foulds
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Pound
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Julie Quet
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Gemma Vomiero
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Sakran
- Department of Paediatrics, Queen's University, Oshawa, Ontario, Canada
| | - Natascha Kozlowski
- Research, Lakeridge Health Ajax Pickering Hospital, Ajax, Ontario, Canada
| | - Ann Bayliss
- Trillium Health Partners, University of Toronto, Mississauga, Ontario, Canada
| | - Ronik Kanani
- Department of Pediatrics, North York General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anupam Sehgal
- Department of Paediatrics, Queen's University, Kingston, Ontario, Canada
| | - Eleanor M Pullenayegum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arun Reginald
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus Wolter
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Sanjay Mahant
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine and the Paediatric Outcomes Research Team (PORT), Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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14
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Management of Orbital Complications of Acute Rhinosinusitis in Pediatric Patients: A 15-Year Single-Center Experience. Pediatr Infect Dis J 2019; 38:994-998. [PMID: 31306351 DOI: 10.1097/inf.0000000000002414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The major clinical dilemma managing acute rhinosinusitis (ARS) in pediatric population is distinguishing uncomplicated rhinosinusitis from a complicated bacterial ARS and orbital complications, the latter requiring antimicrobials and surgical intervention. However, factors associated with severe orbital complications and the optimum management strategy remains controversial. The objectives of this study were to characterize the clinical outcomes of children with orbital complications of ARS and to identify risk factors associated with disease severity. METHODS This retrospective cohort analysis evaluated the clinical outcomes of 61 children admitted for orbital complications between January 1, 2002 and December 31, 2017. Descriptive statistics were performed to examine the demographics and clinical findings. We compared groups using Mann-Whitney U test for continuous variables and χ for categorical variables. RESULTS Although two-thirds of children had received prehospital antibiotics, half of the cohort presented with post-septal orbital complications. While 83% of isolates obtained from the same patients were susceptible to the prehospital antibiotics given, the majority of those who received prehospital antibiotics nevertheless required surgical intervention. We observed significant association between the age of presentation and disease severity. Children >5 years of age presented with more severe orbital complications despite prehospital antibiotics and were more likely to require surgical intervention (P < 0.001). CONCLUSIONS In this study, stage II/III orbital complications at presentation and older age were the most important determinants of medical treatment failure. Early referral to eye, nose and throat (ENT) should be considered for children >5 years with ARS due to worse orbital complications despite prehospital antibiotics.
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Shen A, Katowitz WR, Revere KE. A 12-Month-Old Boy With Bilateral Facial Swelling and Proptosis. JAMA Ophthalmol 2018; 136:823-824. [PMID: 29677235 DOI: 10.1001/jamaophthalmol.2017.5804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alice Shen
- currently a medical student at Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - William R Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen E Revere
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Management of pediatric orbital cellulitis: A systematic review. Int J Pediatr Otorhinolaryngol 2018; 110:123-129. [PMID: 29859573 DOI: 10.1016/j.ijporl.2018.05.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/29/2018] [Accepted: 05/03/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Orbital complications account for 74-85% of all complications from acute sinusitis, more often affect the pediatric population, and can result in devastating consequences. Therefore these patients require prompt diagnosis and proper management. We review and summarize the current literature to determine the appropriate management of each stage of pediatric orbital cellulitis and offer a new comprehensive literature-based algorithm. METHODS Data sources were PubMed/MEDLINE, and Google Scholar. Studies relevant to the management of each subcategory of the Chandler criteria in the pediatric population, limited to the period 1997 through Jan 2018, were compiled and interpreted. Seventy-one studies were reviewed in total. RESULTS Pre-septal and post-septal cellulitis can generally be managed non-surgically, while orbital abscess and cavernous sinus thrombosis are managed surgically. For subperiosteal abscess, non-surgical medical management has been successful in certain patients. Results of the literature review were summarized, and subsequently developed into a comprehensive algorithm for management, including criteria for age, location, and volume of abscess on imaging. CONCLUSIONS Orbital cellulitis, particularly subperiosteal abscesses, in children is not an absolute indication for immediate surgical intervention. Conservative measures can be safe and effective if appropriately used, depending on patient characteristics, clinical course, and imaging.
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Atfeh MS, Singh K, Khalil HS. Orbital infections: a complete cycle 7-year audit and a management guideline. Eur Arch Otorhinolaryngol 2018; 275:2079-2088. [PMID: 29869159 DOI: 10.1007/s00405-018-5025-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Orbital infections are regularly encountered and are managed by various healthcare disciplines. Sepsis of the orbit and adjacent tissues can be associated with considerable acute complication and long-term sequelae. Therefore, prompt recognition and management of this condition are crucial. This article presents the outcomes of a 7-year complete cycle audit project and describes the development of the new local guideline on the management of orbital infections in our tertiary centre. METHODS (1) A retrospective 5-year audit cycle on patients with orbital infections. (2) A review of available evidence on the management of orbital infections. (3) A new local multidisciplinary guideline on the management of orbital infections. (4) A retrospective 2-year second audit cycle to assess the clinical outcomes. RESULTS Various disciplines intersect in the management of orbital infections. Standardising the management of this condition proved to be achievable through the developed guideline. However, room for improvement in practice exists in areas such as the promptness in referring patients to specialist care, the multidisciplinary assessment of patients on admission, and the improvement of scanning requests of patients.
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Affiliation(s)
- Mihiar Sami Atfeh
- ENT Department, University Hospitals Plymouth NHS Trust, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Kathryn Singh
- Department of Critical Care, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Hisham Saleh Khalil
- ENT Department, University Hospitals Plymouth NHS Trust, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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Selected Disorders of the Eye. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nagarakanti S, Bishburg E, Brown M. Cavernous Sinus Thrombosis due to Streptococcus mitis and Staphylococcus lugdunensis. J Clin Diagn Res 2016; 10:OD13-OD14. [PMID: 27790500 DOI: 10.7860/jcdr/2016/21521.8545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/07/2016] [Indexed: 12/25/2022]
Abstract
Cavernous Sinus Thrombosis (CST) is a rare, life-threatening condition that may result from the direct spread of infection from the nose, ears, teeth or sinuses. It is most commonly caused by Staphylococcus aureus and Streptococcus sp. We present a case of CST caused by Strepotococcus mitis and Staphylococcus lugdunensis. Early surgical intervention with aggressive medical management is needed as the syndrome carries a high mortality. To our knowledge this is the first case of CST associated with these two organisms.
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Affiliation(s)
- Sandhya Nagarakanti
- Clinical Assistant Professor, Newark Beth Israel Medical Center , Newark, New Jersey, USA
| | - Eliahu Bishburg
- Clinical Associate Professor, Newark Beth Israel Medical Center , Newark, New Jersey, USA
| | - Melinda Brown
- Attending Physician and Clinical Researcher, St. Michael Medical Center , Newark, New Jersey, USA
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Crosbie RA, Nairn J, Kubba H. Management of paediatric periorbital cellulitis: Our experience of 243 children managed according to a standardised protocol 2012-2015. Int J Pediatr Otorhinolaryngol 2016; 87:134-8. [PMID: 27368460 DOI: 10.1016/j.ijporl.2016.06.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/31/2016] [Accepted: 06/04/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Paediatric periorbital cellulitis is a common condition. Accurate assessment can be challenging and appropriate use of CT imaging is essential. We audited admissions to our unit over a four year period, with reference to CT scanning and adherence to our protocol. METHODS Retrospective audit of paediatric patients admitted with periorbital cellulitis, 2012-2015. RESULTS Total of 243 patients included, mean age 4.7 years with slight male predominance, the median length of admission was 2 days. 48/243 (20%) underwent CT during admission, 25 (52%) of these underwent surgical drainage. As per protocol, CT brain performed with all orbital scans; no positive intracranial findings on any initial scan. Three children developed intracranial complications subsequently; all treated with antibiotics. Our re-admission rate within 30 days was 2.5%. CONCLUSIONS Our audit demonstrates benefit of standardising practice and the low CT rate, with high percentage taken to theatre and no missed abscesses, supports the protocol. There may be an argument to avoid CT brain routinely in all initial imaging sequences in those children without neurological signs or symptoms.
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Affiliation(s)
- Robin A Crosbie
- Department of Otolaryngology, Royal Hospital for Children, Glasgow, Scotland.
| | | | - Haytham Kubba
- Department of Otolaryngology, Royal Hospital for Children, Glasgow, Scotland
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Selected Disorders of the Eye. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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