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Optimizing antimicrobial routes: risk factor analysis for intravenous therapy in children with preseptal orbital
Roberto Privato1, Emanuela Inserra2, Francesco Pezzoli1
1Department of Health Sciences, University of Florence, Florence, Italy.
Insights
Oral antibiotics, fever, and severe eyelid swelling predict the need for intravenous therapy in pediatric preseptal orbital cellulitis. The ASSET score may help identify severe cases, potentially reducing unnecessary IV antibiotic use.
Area of Science:
- Pediatric Infectious Diseases
- Ophthalmology
- Clinical Decision Making
Background:
- Optimal antimicrobial route for pediatric preseptal orbital cellulitis (OC) is unclear.
- Distinguishing mild from severe OC is challenging, leading to frequent intravenous (IV) antibiotic use.
- The ASSET score for skin infection severity lacks validation in preseptal OC.
Purpose of the Study:
- Identify clinical and laboratory predictors of severe preseptal OC requiring IV treatment.
- Evaluate the utility of the ASSET score in pediatric preseptal OC.
Main Methods:
- Retrospective study of pediatric preseptal OC cases (January 2017 - June 2024).
- Data collection included demographics, clinical presentation, blood tests, and management.
- Analysis focused on factors associated with IV vs. oral antibiotic administration.
Main Results:
- Prior oral antibiotic trials, fever, and severe eyelid swelling predicted the need for IV therapy (p<0.001).
- Patients requiring IV therapy had a significantly higher median ASSET score (p<0.001).
- Significant differences in laboratory findings were observed between IV and non-IV treated groups.
Conclusions:
- Clinical factors like prior oral therapy, systemic symptoms (fever), and severe swelling guide IV antibiotic decisions in preseptal OC.
- The ASSET score shows promise for identifying severe preseptal OC, potentially reducing IV antibiotic use.
- Ancillary blood tests may aid in detecting preseptal OC cases necessitating IV treatment.
Background:
The optimal route of antimicrobial administration for preseptal orbital cellulitis (OC) in children remains uncertain. While mild cases may be managed with oral therapy, distinguishing between mild and severe presentations is challenging. The recently proposed ASSET score offers a tool for assessing the severity of skin and soft tissue infections, but prospective validation in large cohorts of preseptal OC is lacking. As a result, most patients with periorbital infections are admitted for intravenous (IV) antibiotics. This study aims to identify clinical and laboratory features predictive of severe preseptal OC requiring IV treatment.
Methods:
A retrospective study was conducted at Meyer Children's Hospital IRCCS, Florence, reviewing outpatient records for OC cases from January 2017 to June 2024. Data on age, sex, clinical presentation, blood tests, and management were collected.
Results:
Previously initiated oral therapy was associated with the need for IV therapy (p < 0.001), as well as the presence of fever (p < 0.001), and severe eyelid swelling (p < 0.001). The median ASSET score was higher in patients with preseptal OC requiring IV therapy (p < 0.001). Differences in laboratory findings were noted between children with preseptal OC managed with and without IV antibiotics.
Conclusions:
Previous trials of oral antibiotics, systemic features, and severe swelling influence clinicians' decisions to initiate IV antibiotics in preseptal OC. If validated for preseptal OC, the application of the ASSET score could significantly reduce the number of children treated with IV antibiotics. Ancillary blood tests may be useful for detecting preseptal OC requiring IV treatment.
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