Factors Associated with Surgery and Imaging Characteristics in Severe Orbital Infections

Gill, Peter; Drouin, Olivier; Pound, Catherine M.; Quet, Julie; Wahi, Gita; Bayliss, Ann; Vomiero, Gemma; Foulds, Jessica L.; Kanani, Ronik; Sakran, Mahmoud; Sehgal, Anupam; Pullenayegum, Eleanor; Widjaja, Elysa; Reginald, Arun; Wolter, Nikolaus E.; Oni, Semipe; Anwar, Rashid; Cichon, Jessica; Louriachi, Hossam; Ge, Yipeng; Kirolos, Nardin; Patel, Ashaka; Jasani, Hardika; Kornelsen, Emily; Chugh, Ashton; Gouda, Sandra; Akbaroghli, Susan; McKerlie, Morgyn; Parkin, Patricia C.; Mahant, Sanjay

doi:10.1016/j.jpeds.2022.05.010

Cited by 8 publications

(5 citation statements)

References 31 publications

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“…Chandler score is a marker of disease severity23 and was classified as I/II (periorbital or orbital cellulitis only) or III/IV/V (subperiosteal/orbital abscess or cavernous sinus thrombosis). Children who did not have a CT scan or had a CT scan >24 hours after hospital admission, were classified as having a Chandler I/II score (cellulitis only), consistent with previous studies 22 24…”

Section: Methodssupporting

confidence: 58%

“…Covariates included age (years), sex (male/female), continuous white blood cell (WBC) count (×10 9 /L), C-reactive protein (CRP) categories (≤40, >40 to ≤80, >80 to ≤120, >120 mg/L, not done), antibiotics prior to ED visit (yes/no), proptosis (yes/no), transfer from a community to a children’s hospital (yes/no) and Chandler score. Elevated WBC count, antibiotics prior to hospital admission and proptosis at initial presentation are associated with the need for surgery 22. Children admitted to a children’s hospital or transferred from a community hospital may have a higher degree of acuity impacting their empiric antibiotic selection.…”

Section: Methodsmentioning

confidence: 99%

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Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study

Krueger,

Nguyen,

Mahant

et al. 2024

Arch Dis Child

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ObjectiveTo determine the association of initial empiric antibiotic regimens with clinical outcomes in hospitalised children with severe orbital infections.DesignMulti-centre observational cohort study using data from 2009 to 2018 clinical records.SettingCanadian children’s hospitals (7) and community hospitals (3).PatientsChildren between 2 months and 18 years hospitalised for >24 hours with severe orbital infections.InterventionsEmpiric intravenous antibiotic regimen in the first 24 hours of hospitalisation.Main outcome measuresLength of hospital stay and surgical intervention using multivariable median regression and multivariate logistic regression, with adjustment for covariates.ResultsOf 1421 patients, 60.0% were male and the median age was 5.5 years (IQR 2.4–9.9). Median length of stay was 86.4 hours (IQR 56.9–137.5) and 180 (12.7%) received surgical intervention. Patients receiving broad-spectrum empiric antibiotics had an increased median length of stay, ranging from an additional 13.8 hours (third generation cephalosporin and anaerobic coverage) to 19.5 hours (third generation cephalosporin, staphylococcal and anaerobic coverage). No antibiotic regimen was associated with a change in the odds of surgical intervention. These findings remained unchanged in sensitivity analyses restricted to more severely ill patients. There was a twofold increase in the percentage of patients receiving the broadest empiric antibiotic regimens containing both staphylococcal and anaerobic coverage from 17.8% in 2009 to 40.3% in 2018.ConclusionsEmpiric use of broad-spectrum antibiotics with staphylococci and anaerobic coverage was associated with longer length of stay and similar rates of surgery in children with orbital infections. There is an urgent need for comparative effectiveness studies of various antibiotic regimes.

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Section: Methodssupporting

confidence: 58%

Section: Methodsmentioning

confidence: 99%

Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study

Krueger,

Nguyen,

Mahant

et al. 2024

Arch Dis Child

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“…Periorbital and orbital cellulitis are inflammatory conditions of the eye that can be difficult to distinguish using clinical examination alone, particularly in young children [ 1 ]. Clinically, both conditions present with redness and swelling of the eye, but their etiology, management and prognosis are different.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic test accuracy of ultrasound for orbital cellulitis: A systematic review

Anwar,

Mahant,

Agbaje-Ojo

et al. 2023

PLoS ONE

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Background Periorbital and orbital cellulitis are inflammatory conditions of the eye that can be difficult to distinguish using clinical examination alone. Computer tomography (CT) scans are often used to differentiate these two infections and to evaluate for complications. Orbital ultrasound (US) could be used as a diagnostic tool to supplement or replace CT scans as the main diagnostic modality. No prior systematic review has evaluated the diagnostic test accuracy (DTA) of ultrasound compared to cross-sectional imaging. Objective To conduct a systematic review of studies evaluating the DTA of orbital ultrasound compared with cross-sectional imaging, to diagnose orbital cellulitis. Methods MEDLINE, EMBASE, CENTRAL, and Web of Science were searched from inception to August 10, 2022. All study types were included that enrolled patients of any age with suspected or diagnosed orbital cellulitis who underwent ultrasound and a diagnostic reference standard (i.e., CT or magnetic resonance imaging [MRI]). Two authors screened titles/abstracts for inclusion, extracted data, and assessed the risk of bias. Results Of the 3548 studies identified, 20 were included: 3 cohort studies and 17 case reports/series. None of the cohort studies directly compared the diagnostic accuracy of ultrasound with CT or MRI, and all had high risk of bias. Among the 46 participants, diagnostic findings were interpretable in 18 (39%) cases which reported 100% accuracy. We were unable to calculate sensitivity and specificity due to limited data. In the descriptive analysis of the case reports, ultrasound was able to diagnose orbital cellulitis in most (n = 21/23) cases. Conclusion Few studies have evaluated the diagnostic accuracy of orbital ultrasound for orbital cellulitis. The limited evidence based on low quality studies suggests that ultrasound may provide helpful diagnostic information to differentiate orbital inflammation. Future research should focus studies to determine the accuracy of orbital US and potentially reduce unnecessary exposure to radiation.

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“…4 In contrast to preseptal and orbital cellulitis, SPA and OA often require surgical intervention and implicate a longer duration of hospitalization. 5 It remains unknown whether SPA and OA pose unique considerations for evaluation, treatment, and prognosis when compared as distinct conditions. 6,7…”

mentioning

confidence: 99%

“…All patients in the series underwent surgical drainage, potentially supporting more aggressive management in OA compared with SPA. 5,7,13 To the best of the authors’ knowledge, the present study conducted the first direct comparison of orbital SPA and OA, with the aim of elucidating differences in presenting features, management, and outcomes. The following characterization of OA additionally helps to address the dearth of data available on this condition and investigates a potential role for nonsurgical management in OA.…”

mentioning

confidence: 99%

Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes

Gibbons,

Niknahad,

Bacorn

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: To compare the clinical features, management, and outcomes between orbital cellulitis patients with subperiosteal abscess (SPA) and those with orbital abscess (OA). Methods: A retrospective study was conducted at a tertiary care center through medical record search to identify patients with orbital cellulitis from January 1, 2000 to December 31, 2022. Charts were screened for those with radiographic evidence of SPA or OA. Demographic data and presenting clinical features were compared between the 2 cohorts. Primary outcomes compared included rates of surgical intervention, reoperation, and readmission; and length of hospital stay and final vision. Results: A total of 189 patients, 162 with SPA and 27 with OA, met the criteria. The OA group (mean 46.5 ± 18.6 years) was older than the SPA group (mean 19.1 ± 21.4 years). Comorbid sinusitis was significantly more common in the SPA cohort (95.7% SPA; 70.4% OA; p < 0.001), while OA was more likely to occur with orbital trauma (29.6% vs. 8.0%; p = 0.003), implanted hardware (11.1% vs. 0.6%; p = 0.005), and comorbid diabetes (22.2% vs. 4.3%; p = 0.001). OA patients more often presented with a relative afferent pupillary defect (21.7% vs. 3.9%; p = 0.005), vision worse than 20 of 50 (42.3% vs. 16.2%; p = 0.005), and methicillin-resistant Staphylococcus aureus infection (20.8% vs. 5.8%; p = 0.036). OA was associated with a higher reoperation rate (47.8% vs. 21.3%; p = 0.019), readmission rate (18.5% vs. 5.6%, p = 0.047), and limited extraocular motility at follow-up (4.3% vs. 25%; p = 0.013); while mean length of hospital stay and final visual acuity were similar. Conclusion: OA may affect an older population with a divergent risk factor profile compared with SPA. OA may cause more severe functional impairment on presentation, warranting more aggressive management to achieve visual outcomes similar to SPA.

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Factors Associated with Surgery and Imaging Characteristics in Severe Orbital Infections

Cited by 8 publications

References 31 publications

Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study

Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study

Diagnostic test accuracy of ultrasound for orbital cellulitis: A systematic review

Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes

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