Integrated analysis of risk factors, visual prognosis, and pathogens in pediatric post-traumatic endophthalmitis: a retrospective cohort study

TL;DR

This study identifies risk factors, visual outcomes, and common pathogens in children with post-traumatic eye infections, focusing on rural male populations.

Contribution

The study provides novel insights into pediatric post-traumatic endophthalmitis by analyzing risk factors, visual prognosis, and pathogens in a Chinese cohort.

Findings

White blood cell count (WBC) is a valuable biomarker for diagnosing post-traumatic endophthalmitis in children.

Gram-positive cocci, especially Staphylococcus and Streptococcus, are the most common pathogens in pediatric post-traumatic endophthalmitis.

Delayed medical consultation and elevated inflammatory markers are critical risk factors for poor visual outcomes.

Abstract

Research on pediatric ocular trauma remains limited, and clinical management is often extrapolated from adult data. This study aimed to analyze the risk factors, visual prognosis, and microbiological characteristics of infectious endophthalmitis following pediatric ocular trauma, thereby providing evidence for clinical decision-making.

A retrospective cohort study was conducted on 108 hospitalized children with ocular trauma treated at Hebei Eye Hospital between January 2019 and June 2025. Three parallel analyses were performed within the same population: (1) 54 children (54 eyes) with post-traumatic infectious endophthalmitis (endophthalmitis group) were matched to 54 children (54 eyes) without endophthalmitis (control group). Clinical features and inflammatory markers were compared, and risk factors were identified using receiver operating characteristic (ROC) curves and logistic regression; (2) patients were categorized into good-vision (55 cases) and poor-vision (33 cases) groups. Baseline data and inflammatory indices were compared to classify independent risk factors for poor visual outcome; and (3) pathogen culture and antibiotic susceptibility results were summarized.

A total of 108 children were included, of whom 83 (76.85%) were male and 98 (90.74%) were rural residents. Risk factors for post-traumatic infectious endophthalmitis included delayed presentation, elevated white blood cell count (WBC), neutrophils (NEUT), monocytes (MON), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and systemic immune-inflammation index (SII) (OR = 0.979, 1.413, 1.29, 51.404, 166.58, 2.019, and 1.001, respectively). WBC (OR = 1.404) was identified as an independent risk factor. WBC presented good diagnostic performance with an AUC of 0.722; combined predictors improved the AUC to 0.745. Risk factors for poor visual prognosis included endophthalmitis, lens injury, elevated WBC, and elevated NEUT (OR = 4.667, 6.176, 1.152, and 1.15, respectively), with a combined AUC of 0.732. Among culture-positive cases in the endophthalmitis group, bacterial infection predominated (81.48%, 22/27). Gram-positive cocci were most common, primarily Staphylococcus and Streptococcus species, with broad susceptibility to cephalosporins, penicillin, vancomycin, aminoglycosides, and fluoroquinolones.

Pediatric traumatic infectious endophthalmitis predominantly occurs in male children from rural areas. WBC is a valuable diagnostic biomarker, and the combination of multiple inflammatory indices further improves diagnostic accuracy. Delayed medical consultation is a critical risk factor. Patients with less severe lens damage and lower inflammatory marker levels are more likely to achieve favorable visual outcomes. Bacterial infections, especially Gram-positive cocci, are the predominant pathogens.

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