Purpose

This study provides an updated analysis of microbial trends in pediatric orbital cellulitis.

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Methods

A retrospective study analyzing diagnostic trends and clinical presentation of pediatric orbital cellulitis treated between 2011 and 2023.

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Results

A total of 390 pediatric cases of orbital cellulitis were identified; the mean age was 7.7 years and 63.8% of patients were male (n=249). Among patients presenting with constitutional symptoms (92.1%, n=359), the most common were fever (74.9%, n=269), headache (49.9%, n=179), nausea/vomiting (28.4%, n=102), and lethargy/fatigue (28.1%, n=101).

Orbital subperiosteal abscesses were found on initial imaging in 249 (63.8%) patients, most commonly along the medial wall (84.3%, n=210), followed by the superior (31.3%, n=78), inferior (10.8%, n=27), and lateral (6.0%, n=5) walls. Positive cultures were isolated from the middle meatus (36.9%, n=144), ESS (29.7%, n=116), and orbit (12.6%, n=49). Cultures were most often positive for methicillin susceptible Staphylococcus aureus (MSSA) (24.3%, n=75), Staphylococcus intermedius (20.1%, n=62), coagulase-negative staphylococci (CoNS) (17.8%, n=55), Streptococcus pyogenes (12.6%, n=39), Corynebacterium (7.4%, n=23), and methicillin resistant Staphylococcus aureus (MRSA) (6.8%, n=21).

Surgical intervention was required in 47.2% (n=184) of patients. All patients were managed medically with intravenous and oral antibiotics for an average of 8.8 days during admission. Steroids were administered in 64 patients (16.4%).

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Conclusion

Sinusitis and orbital subperiosteal abscesses remained highly prevalent, with MSSA emerging as the most common causative organism. While CoNS, Staphylococcus intermedius, and Streptococcus pyogenes were also frequently isolated, MRSA was less commonly identified compared to prior reports. Nearly half of patients required surgical intervention, highlighting the importance of multidisciplinary care. These findings underscore evolving microbiologic trends and support the need for targeted diagnostic and therapeutic strategies in pediatric orbital cellulitis.

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Additional Authors

First name	Last name	Base Hospital / Institution
Lucy	Mudie	Baylor College of Medicine
George	Villatoro	Baylor College of Medicine
Monia	Reding	Oregon Health & Science University
Patrick	Hunt	Yale University
Katherine	Williams	Baylor College of Medicine/Texas Children’s Hospital
Michael	Yen	Baylor College of Medicine

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