Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study

Carsten Krueger; Emily Lan-Vy Nguyen; Sanjay Mahant; Cornelia M Borkhoff; Jessica Cichon; Olivier Drouin; Catherine Pound; Julie Quet; Gita Wahi; Ann Bayliss; Gemma Vomiero; Jessica Foulds; Ronik Kanani; Mahmoud Sakran; Anupam Sehgal; Eleanor Pullenayegum; Elysa Widjaja; Arun Reginald; Nikolaus Wolter; Patricia Parkin; Peter J Gill; Periorbital and Orbital Cellulitis (POC) Multicenter Study Group and the Canadian Paediatric Inpatient Research Network (PIRN); Periorbital and Orbital Cellulitis (POC) Multicenter Study Group and Canadian Pediatric Inpatient Research Network (PIRN)

doi:10.1136/archdischild-2023-326175

Association of empiric antibiotic selection and clinical outcomes in hospitalised children with severe orbital infections: a retrospective cohort study

Arch Dis Child. 2024 Apr 8:archdischild-2023-326175. doi: 10.1136/archdischild-2023-326175. Online ahead of print.

Authors

Carsten Krueger¹, Emily Lan-Vy Nguyen², Sanjay Mahant^{2

3

4

5}, Cornelia M Borkhoff^{2

3

4

5}, Jessica Cichon⁴, Olivier Drouin^{6

7

8}, Catherine Pound^{9

10}, Julie Quet^{9

10}, Gita Wahi¹¹, Ann Bayliss¹², Gemma Vomiero¹, Jessica Foulds^{13

14}, Ronik Kanani¹⁵, Mahmoud Sakran¹⁶, Anupam Sehgal¹⁷, Eleanor Pullenayegum^{4

18}, Elysa Widjaja², Arun Reginald^{2

19}, Nikolaus Wolter^{2

20}, Patricia Parkin^{2

3

4

5}, Peter J Gill^{21

3

4

5}; Periorbital and Orbital Cellulitis (POC) Multicenter Study Group and the Canadian Paediatric Inpatient Research Network (PIRN); Periorbital and Orbital Cellulitis (POC) Multicenter Study Group and Canadian Pediatric Inpatient Research Network (PIRN)

Affiliations

¹ Alberta Children's Hospital, Calgary, Alberta, Canada.
² The Hospital for Sick Children, Toronto, Ontario, Canada.
³ Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
⁴ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
⁵ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
⁶ Division of General Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.
⁷ Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Quebec, Canada.
⁸ Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada.
⁹ Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
¹⁰ Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
¹¹ Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
¹² Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada.
¹³ Stollery Children's Hospital, Edmonton, Alberta, Canada.
¹⁴ Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
¹⁵ North York General Hospital, Toronto, Ontario, Canada.
¹⁶ Lakeridge Health, Oshawa, Ontario, Canada.
¹⁷ Kingston Health Sciences Centre, Kingston, Ontario, Canada.
¹⁸ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹⁹ Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada.
²⁰ Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
²¹ The Hospital for Sick Children, Toronto, Ontario, Canada peter.gill@sickkids.ca.

PMID: 38589203
DOI: 10.1136/archdischild-2023-326175

Abstract

Objective: To determine the association of initial empiric antibiotic regimens with clinical outcomes in hospitalised children with severe orbital infections.

Design: Multi-centre observational cohort study using data from 2009 to 2018 clinical records.

Setting: Canadian children's hospitals (7) and community hospitals (3).

Patients: Children between 2 months and 18 years hospitalised for >24 hours with severe orbital infections.

Interventions: Empiric intravenous antibiotic regimen in the first 24 hours of hospitalisation.

Main outcome measures: Length of hospital stay and surgical intervention using multivariable median regression and multivariate logistic regression, with adjustment for covariates.

Results: Of 1421 patients, 60.0% were male and the median age was 5.5 years (IQR 2.4-9.9). Median length of stay was 86.4 hours (IQR 56.9-137.5) and 180 (12.7%) received surgical intervention. Patients receiving broad-spectrum empiric antibiotics had an increased median length of stay, ranging from an additional 13.8 hours (third generation cephalosporin and anaerobic coverage) to 19.5 hours (third generation cephalosporin, staphylococcal and anaerobic coverage). No antibiotic regimen was associated with a change in the odds of surgical intervention. These findings remained unchanged in sensitivity analyses restricted to more severely ill patients. There was a twofold increase in the percentage of patients receiving the broadest empiric antibiotic regimens containing both staphylococcal and anaerobic coverage from 17.8% in 2009 to 40.3% in 2018.

Conclusions: Empiric use of broad-spectrum antibiotics with staphylococci and anaerobic coverage was associated with longer length of stay and similar rates of surgery in children with orbital infections. There is an urgent need for comparative effectiveness studies of various antibiotic regimes.

Keywords: Child Health; Infectious Disease Medicine; Ophthalmology; Paediatrics.