Posters

129 Orbital abscesses in children: an update on microbiology trends and antibiotic selection

Abstract

Orbital abscesses are a common cause of morbidity in children. This study aims to provide an update on the microbiology, sensitivity rates and antibiotic prescribing patterns for orbital abscesses at Scotland’s largest paediatric tertiary centre. This is essential for empirical antibiotic choices given the rapidly growing rates of resistance among commonly encountered isolates.

A retrospective case note review of all patients admitted to the Royal Hospital for Children (RHC) in Glasgow between April 2019 and 2022 with an orbital abscess that underwent incision and drainage. Exclusion criteria included patients with underlying anatomic eye abnormalities and/or immunodeficiency.

Seventeen orbital abscesses were identified. Streptococcus pyogenes was the commonest micro-organism (47 per cent), followed by Streptococcus intermedius (24 per cent). One abscess grew Fusobacterium necrophorum complicated by a subdural empyema and Lemierre’s syndrome. Most organisms were widely sensitive; there was a single episode of penicillin resistance in an abscess caused by S. aureus. The most common initial antibiotic regimen was a combination of flucloxacillin and cefotaxime.

Gram positive cocci remain the most common organisms isolated in orbital abscesses, with a relative increase in the Streptococcus anginosus group compared to the literature. In approximately half of the identified cases, the antibiotics were changed to a regimen containing clindamycin. Resistance among orbital abscesses remains low.

Empirical use IV cefotaxime and flucloxacillin is recommended. Additional anaerobic cover (e.g., metronidazole, clindamycin) should only be added if there is no clinical improvement after 24-36 hours.

Article metrics
Altmetric data not available for this article.
Dimensionsopen-url