Antibiotic Choices for Pediatric Periorbital Cellulitis-A 20-Year Retrospective Study from Taiwan

Area of Science:

• Ophthalmology
• Infectious Diseases
• Pediatrics

Background:

• Delayed treatment of pediatric periorbital cellulitis can lead to severe outcomes.
• Antibiotic efficacy against causative bacteria evolves, necessitating updated treatment guidelines.
• Understanding current bacterial profiles and antibiotic susceptibilities is crucial for effective pediatric periorbital cellulitis management.

Purpose of the Study:

• To compare bacterial changes and antibiotic susceptibility in pediatric periorbiorbital cellulitis over two decades (2000-2009 vs. 2010-2019).
• To identify appropriate antibiotic options for empirical use in pediatric patients.
• To inform clinical decisions regarding antibiotic selection for periorbital cellulitis.

Main Methods:

• Retrospective analysis of 207 pediatric patients with preseptal and orbital cellulitis from 2000-2019.
• Comparison of patient characteristics, etiologies, culture sites, isolated bacteria, and antibiotic susceptibility tests between two decades.
• Statistical analysis to identify trends in etiologies and bacterial resistance.

Main Results:

• Sinusitis as an etiology significantly decreased, while insect/animal bites showed an increasing trend.
• Staphylococcus aureus remained the most common bacteria, with a significant increase in methicillin-resistant S. aureus (MRSA) infections in recent decades.
• Vancomycin demonstrated ideal efficacy against MRSA, while oxacillin efficacy decreased, correlating with the rise in MRSA.

Conclusions:

• The increasing prevalence of MRSA in pediatric periorbital cellulitis necessitates a shift in empirical antibiotic strategies.
• Vancomycin is recommended for MRSA infections, while oxacillin's decreasing efficacy highlights the need for alternative choices.
• This study provides evidence-based antibiotic recommendations for common isolates in pediatric periorbital cellulitis, aiding timely empirical treatment.