Orbital complications of pediatric acute rhinosinusitis in the pneumococcal conjugate vaccine era

Lior Friedrich; Re'em Sadeh; Itai Hazan; Sofia Kordeluk; El-Saied Sabri; Erez Tsumi; Elchanan Zloczower; Ron Leibovitz; Eugene Leibovitz; Daniel Kaplan; Mordechai Kraus; Oren Ziv

doi:10.1016/j.pedneo.2023.12.009

Orbital complications of pediatric acute rhinosinusitis in the pneumococcal conjugate vaccine era

Pediatr Neonatol. 2024 Jun 13:S1875-9572(24)00090-1. doi: 10.1016/j.pedneo.2023.12.009. Online ahead of print.

Authors

Affiliations

¹ Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
² Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
³ Division of Ophthalmology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
⁴ Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
⁵ Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
⁶ Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: [email protected].

PMID: 38886146
DOI: 10.1016/j.pedneo.2023.12.009

Abstract

Objectives: To evaluate the impact of the pneumococcal conjugate vaccines (PCVs) introduction on the orbital complications of acute rhino-sinusitis (OC-ARS).

Methods: A retrospective cohort study of all pediatric patients with OC-ARS during the period 2002-2019. Data included clinical, demographic, laboratory, and microbiology findings. Patients were divided into three groups: before PCV7 introduction (group 1), after PCV7 and before PCV13 (group 2), and after PCV13 (group 3).

Results: Of 265 enrolled patients, 117, 39, and 109 were assigned to groups 1, 2, and 3. During the study period, a significant decrease was recorded in the percentages of patients in Chandler classification severity category 1, with an increase in patients in category 3 (P = 0.011). The yearly incidence of OC-ARS decreased from 12.64 cases per 100,000 population in 2002 to 5.56 per 100,000 in 2008, and 2.99 per 100,000 in 2019 (P < 0.001). Patients aged 0-4 years showed a dramatic decrease from 29 cases per 100,000 population in 2002 to 4.27 per 100,000 in 2019 (P < 0.001). The pathogens retrieved from all cultures performed were Streptococcus pneumoniae (32.5%), non-typeable Haemophilus influenzae (27.5%), Streptococcus Species, (12.5%), and Staphylococcus aureus (20%), with no changes in distribution during the study periods. Surgery was performed in 28 (10.6%) patients.

Conclusions: A significant decrease was seen in the overall incidence of OC-ARS, mainly attributable to the decrease in patients aged 0-4 years. An increase was recorded in the severity of the disease following PCVs introduction.

Keywords: Acute rhino-sinusitis; Chandler's classification; Computerized tomography; Microbiology; Orbital complication; Periorbital abscess; Periorbital cellulitis; Pneumococcal conjugated vaccine; Streptococcus pneumoniae; Surgery.