{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:09:25Z","timestamp":1770271765525,"version":"3.49.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"3-4","funder":[{"DOI":"10.13039\/100000993","name":"Battelle","doi-asserted-by":"publisher","award":["FA807518D0005-FA807523F0016"],"award-info":[{"award-number":["FA807518D0005-FA807523F0016"]}],"id":[{"id":"10.13039\/100000993","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000993","name":"Battelle","doi-asserted-by":"publisher","award":["FA807518D0005-FA807523F0016"],"award-info":[{"award-number":["FA807518D0005-FA807523F0016"]}],"id":[{"id":"10.13039\/100000993","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,2,27]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Using data from the large and geographically diverse Military Health System (MHS) beneficiary population, we aimed to characterize and update the epidemiology and microbiology of pediatric orbital cellulitis given previous data are limited to small, single-center studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Following institutional review board approval, we performed a retrospective analysis using the Military Health System admissions, microbiology, and pharmacy data between June 2009 and September 2019. Patients less than 22\u2009years of age with radiological confirmation of orbital cellulitis were included. Demographic data, presence of sinusitis, advanced imaging reports, blood and wound culture results with antibiotic susceptibilities, and antibiotic prescriptions were collected. Descriptive statistics were used to summarize demographic characteristics. Imaging findings were grouped by Chandler\u2019s stage (CS), an imaging-based measure of the progressive severity of orbital involvement. A Cochran\u2013Armitage trend test was used to evaluate the relationship between CS and likelihood of positive confirmatory culture.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There was a male predominance (66.9%) and 55.5% of subjects had comorbid sinusitis. Of the 130 subjects included, 33.8% had one or more positive cultures, 30.8% had a positive wound culture, and 4.6% had a positive blood culture. The most identified organism was coagulase-negative staphylococci (23.3%), followed by Staphylococcus aureus (18.9%), Streptococcus intermedius (17.8%), and strict anaerobes as a group (13.3%). Gram-negative organisms were rare. Twenty-five percent of S. aureus were methicillin-resistant. Clindamycin resistance was identified in 9% of all S. aureus, 50% of coagulase-negative staphylococci, and 25% of S. intermedius. Clindamycin plus ceftriaxone was the most prescribed empiric antibiotic regimen (36.2%). Likelihood of a positive culture significantly increased with advancing CS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Orbital cellulitis occurs most frequently in males with sinusitis. Likelihood of positive wound culture is increased with a more advanced CS. Staphylococcus and Streptococcus spp. and anaerobes are the most identified pathogens in orbital cellulitis, while gram-negative organisms are rare. Empiric antibiotic selection should include an anti-methicillin-resistant S. aureus agent combined with a broad-spectrum beta-lactam and anaerobic coverage.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae394","type":"journal-article","created":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T23:33:11Z","timestamp":1724369591000},"page":"e593-e600","source":"Crossref","is-referenced-by-count":4,"title":["Microbiology and Epidemiology of Orbital Cellulitis in Pediatric and Young Adult Patients"],"prefix":"10.1093","volume":"190","author":[{"given":"Blake T","family":"Cirks","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0047-9352","authenticated-orcid":false,"given":"Kevin M","family":"Claunch","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Walter Reed National Military Medical Center , Bethesda, MD 20889,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"DePerrior","sequence":"additional","affiliation":[{"name":"Battelle Memorial Institute, Defense Centers for Public Health\u2014Portsmouth , Portsmouth, VA 23708,","place":["USA"]},{"name":"Defense Health Agency Public Health, Defense Centers for Public Health\u2014Portsmouth , Portsmouth, VA 23708,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beth","family":"Poitras","sequence":"additional","affiliation":[{"name":"Defense Health Agency Public Health, Defense Centers for Public Health\u2014Portsmouth , Portsmouth, VA 23708,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"issue":"5","key":"2025031111144303800_R1","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1097\/ICU.0000000000000589","article-title":"Paediatric orbital and periorbital infections","volume":"30","author":"Williams","year":"2019","journal-title":"Curr Opin Ophthalmol"},{"issue":"4","key":"2025031111144303800_R2","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1097\/00004397-200110000-00009","article-title":"Orbital cellulitis in children","volume":"41","author":"Jain","year":"2001","journal-title":"Int Ophthalmol Clin"},{"issue":"11","key":"2025031111144303800_R3","doi-asserted-by":"publisher","first-page":"680","DOI":"10.12788\/jhm.3707","article-title":"Evaluation and medical management of the pediatric patient with orbital cellulitis\/abscess: a systematic 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