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Microbiology of bacterial orbital cellulitis—tertiary institutional experiences in South Australia: a multi-centre retrospective study

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Abstract

Purpose

This study describes the microbiology of bacterial orbital cellulitis (OC) over an 11-year period and its clinical associations at three tertiary institutions in Adelaide, South Australia.

Methods

Multi-centre retrospective study of the microbiology of bacterial OC between January 2012 and August 2022. Pre-septal cellulitis was excluded. Differences in means were determined by the Independent Samples t-test, and categorical data was analysed via Pearson’s Chi square. A P-value < 0.05 was statistically significant.

Results

99 patients (male: 69, mean age: 22.0 ± 23.8 years old), of which 70.7% were aged ≤ 18 years. Sinus and orbital abscess cultures had the greatest positive yield (73.7%). Frequency of organisms: Streptococcus species (34.3%), Staphylococcus aureus (28.3%), Haemophilus species (5.1%), mixed anaerobes (3.0%), Enterobacter cloacae (2.0%), Moraxella catarrhalis (1.0%), Pseudomonas aeruginosa (1.0%), Corynebacterium species (1.0%), Klebsiella pneumoniae (1.0%), Proteus mirabilis (1.0%), Citrobacter koseri (1.0%), and Enterococcus species (1.0%). Streptococcus species predominated in the paediatric population, with a statistically significant difference in mean age between Streptococcus species and Staphylococcus aureus (14.1 ± 16.5 vs 27.6 ± 24.6 years old, respectively) (P = 0.028). No organism was cultured in 32.3% of cases. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 28.6% of all Staphylococcus aureus isolates, with 50% occurring between 2021 and 2022.

Conclusion

Yearly microbiological trends have remained largely constant in South Australia. The causative organism was not identified in 32.3% of cases, further emphasising appropriate empirical antibiotics, and obtaining microbiology from various sources. MRSA OC remains of increased clinical and public health concern and may be associated with a more aggressive disease course.

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Acknowledgements

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Authors and Affiliations

  1. The University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, 5000, Australia

    Terence Ang, Jessica Y. Tong & Dinesh Selva

  2. Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia

    Jessica Y. Tong & Dinesh Selva

Authors
  1. Terence Ang
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  2. Jessica Y. Tong
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  3. Dinesh Selva
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Contributions

TA was responsible for the writing the protocol, extracting and analysing data, interpreting results and drafting of the manuscript. JT and DS provided feedback on the manuscript.

Corresponding author

Correspondence to Terence Ang.

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The authors have no financial disclosures or conflicts of interest to declare.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. This research has been approved by the Central Adelaide Local Health Network Human Research Ethics Committee.

Disclosure

This research has been accepted as an oral presentation for the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) 53rd Annual Scientific Congress in 2022. There are no further disclosures.

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Ang, T., Tong, J.Y. & Selva, D. Microbiology of bacterial orbital cellulitis—tertiary institutional experiences in South Australia: a multi-centre retrospective study. Int Ophthalmol 43, 2283–2289 (2023). https://doi.org/10.1007/s10792-022-02624-8

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