目的:近年来,耐甲氧西林金黄色葡萄球菌(MRSA)眼眶蜂窝织炎(OC)引起了越来越多的临床和公共卫生关注。我们介绍了在四个澳大利亚大专院校中遇到的一系列MRSAOC病例。
方法:2013年至2022年在澳大利亚调查MRSAOC的多中心回顾性病例系列。包括所有年龄的患者。
结果:在澳大利亚的四个大专院校中发现了9例培养阳性的非多重耐药MRSA(nmMRSA)OC(7名男性,2女)。平均年龄为17.1±16.7岁(范围为13天至53岁),其中一个是13天,都有免疫能力。8例(88.9%)患者有鼻旁窦疾病,7例(77.8%)有骨膜下脓肿。4例(44.4%)颅内扩张,其中1例(11.1%)并发上矢状窦血栓形成。经验性抗生素,例如静脉注射(IV)头孢噻肟或静脉注射头孢曲松和氟氯西林,已经开始了。在鉴定nmMRSA之后,增加了由万古霉素和/或克林霉素组成的靶向治疗。9名(100%)患者接受了手术干预。平均住院时间为13.7±6.9天(范围3-25天),两名患者因眼眶感染相关并发症而需要入住重症监护病房(ICU)。所有患者预后良好,保持视力和眼外运动,平均随访4.6个月(范围2-9个月)。
结论:NMMRSAOC可以遵循积极的临床过程,在广泛的人群中引起严重的眼眶和颅内并发症。然而,早期识别,在需要时开始使用有针对性的抗生素和手术干预可以有效地处理这些并发症并取得良好的视力结果.
OBJECTIVE: In recent years, methicillin-resistant Staphylococcus aureus (MRSA)
orbital cellulitis (OC) has drawn increasing clinical and public health concern. We present a
case series of MRSA OC encountered at four Australian tertiary institutions.
METHODS: A multi-centre retrospective
case series investigating MRSA OC in Australia from 2013 to 2022. Patients of all ages were included.
RESULTS: Nine cases of culture-positive non-multi-resistant MRSA (nmMRSA) OC were identified at four tertiary institutions across Australia (7 male, 2 female). Mean age was 17.1 ± 16.7 years (range 13-days to 53-years), of which one was 13 days old, and all were immunocompetent. Eight (88.9%) patients had paranasal sinus disease, and seven (77.8%) had a subperiosteal abscess. Four (44.4%) had intracranial extension, including one (11.1%)
case which was also complicated by superior sagittal sinus thrombosis. Empirical antibiotics, such as intravenous (IV) cefotaxime alone or IV ceftriaxone and flucloxacillin, were commenced. Following identification of nmMRSA, targeted therapy consisting of vancomycin and/or clindamycin was added. Nine (100%) patients underwent surgical intervention. Average hospital admission was 13.7 ± 6.9 days (range 3-25 days), with two patients requiring intensive care unit (ICU) admission due to complications related to their orbital infection. All patients had favourable prognosis, with preserved visual acuity and extraocular movements, following an average follow-up period of 4.6 months (range 2-9 months).
CONCLUSIONS: NMMRSA OC can follow an aggressive clinical course causing severe
orbital and intracranial complications across a wide demographic. However, early recognition, initiation of targeted antibiotics and surgical intervention when required can effectively manage these complications and achieve favourable visual outcomes.