Increased Resource Burden of Methicillin-Resistant Staphyloccoccus aureus Orbital Cellulitis in the Pediatric Population

Abstract

Objectives:

Due to the colonization of the nares, the epidemic of community acquired Methicillin-Resistant Staphyloccoccus aureus (MRSA) poses a risk of MRSA head and neck infections. Orbital cellulitis is one such infection that commonly follows sinusitis. This infection occurs posterior to the orbital septum, posing risk to nearby structures. The purpose of this study is to stratify the differences in epidemiology and resource use between MRSA orbital cellulitis and traditional non-MRSA orbital cellulitis.

Methods:

We queried the 2009 Kid Inpatient Database, identifying all cases with a primary diagnosis of International Classification of Disease, ninth revision, clinical modification (ICD-9-CM) code 376.01, orbital cellulitis. We then extracted these cases with a secondary diagnosis of ICD-9-CM code 041.12, MRSA, and compared the two groups using Statistical Analysis Software.

Results:

In 2009, the total number of cases for orbital cellulitis was 2502 with 133 having a secondary diagnosis of MRSA (5.3%). The median age for the MRSA group was older (8yo vs 5yo), with 15-19yo 3.14 times more likely to have MRSA (RR 3.14, 95%CI 2.17-4.56). Facial cellulitis was the most common comorbidity for the MRSA group (14%). The MRSA group was more likely to undergo orbitotomy (RR 2.39, 95%CI 1.56-3.66), accruing higher median total charges ($12595 vs $10131).

Conclusions:

Although MRSA can colonize the nares, MRSA orbital cellulitis more commonly occurs with facial cellulitis. This infection increases with increasing age. Orbital infection with MRSA poses a higher resource burden, requiring more frequent invasive measures.