[Clinical characteristics of periorbital and orbital cellulitis in children]

Objective: To analyze the clinical characteristics, causative pathogens, complications, and treatment outcomes of orbital cellulitis in children. Methods: A retrospective cohort study was performed. Clinical data including clinical characteristics, laboratory tests, pathogen profiles, and treatment were analyzed for 175 pediatric patients with orbital cellulitis admitted to Beijing Children's Hospital, Capital Medical University from January 2016 to December 2023. Patients were categorized by lesion location into periorbital cellulitis (PC) and orbital cellulitis (OC) groups; by complication status into with and without complications. Intergroup comparisons were performed using the chi-square test and Mann-Whitney U test. Logistic regression analysis was used to identify risk factors for complications. Results: Of the 175 patients, 116 were male and 59 were female, with an age at presentation of 3.6 (2.1, 6.7) years. There were 81 patients in the PC group and 94 in the OC group. All patients presented with eyelid and periorbital erythema and edema. The OC group demonstrated higher proportions of males, sinusitis, proptosis, ocular motility disorders, bulbar conjunctival edema, and decreased visual acuity compared to the PC group, C-reactive protein levels, neutrophil counts, and platelet counts in the acute phase were also significantly higher in the OC group (all P<0.05). A definitive microbiological diagnosis was established in 74 cases (42.3%), and a total of 76 pathogenic strains were isolated. The most common pathogen was Staphylococcus aureus, accounting for 47 strains (61.8%), including 33 strains (43.4%) of methicillin-susceptible Staphylococcus aureus, and 14 strains (18.4%) of methicillin-resistant Staphylococcus aureus, followed by Streptococcus intermedius and Streptococcus constellatus with 6 strains each (7.9%), and Streptococcus pneumoniae and Pseudomonas aeruginosa with 4 strainss each (5.3%). Complications developed in 47 cases (26.8%), most commonly orbital abscesses in 29 cases (16.6%), followed by purulent meningitis in 14 cases (8.0%). Multivariate logistic regression analysis identified proptosis (OR=3.56, 95%CI 1.49-8.49), decreased visual acuity (OR=4.45, 95%CI 1.27-15.66), and headache (OR=2.76, 95%CI 1.01-7.57) as independent risk factors for complications (all P<0.05). Conclusions: Orbital cellulitis in children commonly presents with eyelid and periorbital redness and swelling. Male sex, sinusitis, proptosis, ocular motility disorders, bulbar conjunctival edema, and decreased vision acuity serve as high-risk indicators for orbital cellulitis. Elevated C-reactive protein, neutrophil count, and platelet counts in the acute phase are laboratory makers closely associated with orbital cellulitis. Staphylococcus aureus is the most common causative pathogen. Decreased vision acuity, proptosis, and headache suggest the presence of complications.