儿童眶蜂窝织炎23例临床分析及文献复习

Clinical characteristics of 23 cases of orbital cellulitis in children and literature review

目的通过病例报道和文献回顾总结儿童眶蜂窝织炎的临床特征。方法对北京儿童医院感染内科2014年1月-2016年11月收治的23例眶蜂窝织炎患儿的临床资料进行总结,复习2006年以来发表的141篇文献。结果按影像学分类眶隔前蜂窝织炎4例(17%)、眼眶蜂窝织炎19例(83%)。男13例(57%),女10例(43%)。<5岁19例(83%),≥5岁4例(17%),平均年龄为3.7岁。秋冬季发病15例(65%)。致病途径包括:眼眶周围组织感染蔓延17例(74%)、血流感染5例(22%)和额部撞伤1例(4%)。血培养阳性5例(24%):肺炎链球菌、耐甲氧西林金黄色葡萄球菌(MRSA)、星座链球菌、铜绿假单胞菌、表皮葡萄球菌各1例;眼/鼻分泌物培养阳性5例:MRSA 2例,凝固酶阴性葡萄球菌、草绿色链球菌、铜绿假单胞菌各1例;脓液培养阳性2例:MRSA、脑膜败血伊丽莎白菌、屎肠球菌混合感染1例,啮蚀艾肯菌、模仿葡萄球菌混合感染1例。所有病例入院血常规白细胞总数、中性粒细胞比例、C反应蛋白均明显增高,均给予静脉应用抗生素治疗,其中外科治疗3例(13%)。平均住院时间为14(4～32)d。检索2006年至今文献发现:儿童眶蜂窝织炎发病率低,主要病因是鼻窦炎和上呼吸道感染,主要病原菌是葡萄球菌和链球菌属。结论儿童眶蜂窝织炎多见于5岁以下者,经验用药应覆盖葡萄球菌和链球菌属,较大脓肿及时切开引流有助于避免严重并发症。

Objective To review the clinical characteristics of orbital cellulitis in children based on 23 cases and relevant literature reports.Methods The clinical data of 23 children treated for preseptal and orbital cellulitis between January 1,2014 and November 31,2016 at Beijing Children's Hospital were reviewed retrospectively.The data included patient sex,age,season,microbiology,disease type,laboratory tests,etiology,complications,treatment,and prognosis.Results The 23 patients were identified with preseptal cellulitis in 4 cases(17%)and orbital cellulitis in 19 cases(83%)based on imaging examination.The demographic data showed 13 males(57%)and 10 females(43%).The average age was 3.7 years(range from 1 month to 12 years and 3 months old),including 19(83%)children<5 years old and 4(17%)patients≥5 years old.Most of the cases occurred in autumn and winter(15 cases,65%).The source of infection included orbital tissue infection in 17 cases(74%),blood infection in 5 cases(22%),and trauma in 1 case(4%).Blood culture was positive in 5 cases(24%).Streptococcus pneumoniae,methicillin-resistant Staphylococcus aureus(MRSA),Streptococcus constellatus,Pseudomonas aeruginosa,and Staphylococcus epidermidis were isolated from one case each.Eye discharge or nasal secretion culture was positive in 5 cases:MRSA strain in 2 cases,coagulase-negative Staphylococcus,Streptococcus viridans,and Pseudomonas aeruginosa in one case each.Pus culture was positive in 2 cases:1 case of MRSA,Elizabethkingia meningosepticum and Enterococcus faecium mixed infection,and 1 case of Eikenella corrodens and Staphylococcus simulans mixed infection.WBC count,neutrophils percentage,C-reactive protein and erythrocyte sedimentation rate significantly increased in all cases when the patient was admitted to hospital.All patients were managed with intravenous antibiotics.Three patients(13%)received surgical treatment.The average length of hospital stay was 14(range from 4 to 32)days.Search with keywords in both Chinese and English literature published since 2006 achieved the following results.The incidence of orbital cellulitis is low,mainly in children.The main cause is sinusitis and upper respiratory infection.The most common pathogens are Staphylococcus and Streptococcus.Conclusions Orbital cellulitis is more prevalent than preseptal cellulitis among children younger than 5 years old.Early empirical antibiotic treatment should cover Staphylococcus and Streptococcus.Serious complications can be avoided by timely incision and drainage in case of large abscess.