Age-related clinical characteristics and treatment patterns in hospitalized orbital cellulitis: a real-world federated database study

Orbital cellulitis is an uncommon but potentially severe infection that can cause vision-threatening complications and death. Differences in clinical characteristics and management between pediatric and adult patients remain incompletely characterized at the population level. This study evaluated demographic characteristics, associated factors, and treatment patterns among patients with orbital cellulitis using a large real-world database. We conducted a retrospective cohort study using the TriNetX US Collaborative Network. Hospitalized patients diagnosed with orbital cellulitis (ICD-10-CM code H05.01) were stratified into pediatric (≤ 18 years) and adult (> 18 years) cohorts. We analyzed demographic characteristics, body mass index (BMI), antecedent upper respiratory infections, chronic sinusitis, comorbid diabetes mellitus (DM) and neoplasms, laboratory parameters, antimicrobial regimens, and ocular adnexal surgery. The age distribution was bimodal, with mean ages of approximately 12 years in the pediatric cohort and 54 years in the adult cohort. Pediatric patients more frequently had antecedent upper respiratory infections and sinusitis and were more commonly treated with lincomycin. Adults had a higher prevalence of overweight/obesity, DM, and neoplasms, and more frequent use of broad-spectrum antimicrobial therapy and ocular adnexal surgery. These findings demonstrate distinct age-related clinical and treatment profiles among hospitalized patients with orbital cellulitis and underscore the importance of considering comorbidity and disease severity when interpreting management patterns.