Subperiosteal abscess of the orbit. Age as a factor in the bacteriology and response to treatment.

BACKGROUND: Earlier studies of subperiosteal abscess secondary to sinusitis showed considerable variation in the clinical course and bacteriology. At one extreme, patients recovered with intravenous antibiotics alone; at the other extreme, complex pathogens persisted despite early surgical drainage and appropriate antibiotics, and visual or intracranial complications occurred. To better direct management of individual patients, this study evaluates the role of patient age in the complexity and responsiveness of subperiosteal abscess.
METHODS: The records of 37 patients with a computed tomography diagnosis of subperiosteal abscess were reviewed. Initial and follow-up culture results were evaluated in the context of prior treatment of individual patients. Responses to therapy and pathogens were compared among three age groups.
RESULTS: Among patients younger than 9 years, 83% either cleared without drainage (25%) or had negative cultures at the time of drainage (58%). In the culture-positive cases, single aerobes were found, and anaerobes were not isolated. Patients 9 to 14 years old showed a transition toward more complex infections. Patients 15 years of age or older all had positive cultures after more than 3 days of antibiotics, which were frequently effective in vitro. Polymicrobial infections were the rule, including anaerobes in every case.
CONCLUSION: Variations in the complexity and responsiveness of subperiosteal abscesses appear to be age-associated. Treatment protocols should consider visual compromise, pain, location of the abscess, which sinuses are involved, intracranial complications, and the age of the patient.