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Infection Rates and Antibiotic Usage in Pediatric Nail Bed Finger Injuries: Analysis of the Pediatric Health Information System (PHIS)
Janet Hsu, BS, Alejandro J. Friedman, MA; Steven M. Koehler, M.D.
Montefiore Medical Center, Bronx, NY
Introduction: Nail bed injuries make up nearly two-thirds of pediatric hand and upper extremity injuries. The benefits of antibiotic use and subsequent infection rates in nail bed injuries remain unclear, especially in the pediatric population. Given the increasing problem of antibiotic resistance, the purpose of this study is to examine factors affecting antibiotic usage and infection rates in order to improve antibiotic stewardship.
Materials & Methods: A retrospective study was done from October 2015 to December 2024 using the Pediatric Health Information System (PHIS) database. PHIS is a database with data from about 50 children's hospitals nationwide. Data was pulled using ICD-9 and 10 codes for finger injuries with damage to the nail for patients less than 18 years old. Only ED visits were included. Demographics, antibiotic usage, and infection rates within 30 days resulting in readmission were analyzed. Statistical analysis included descriptive statistics, Pearson's chi-square analysis, and
t-tests. A
p-value < 0.05 was considered statistically significant.
Results: A total of 5031 patients from 46 hospitals were analyzed (45.3% male, mean age 7.3 ± 5.5 years). The number of patients who received antibiotics was 1689 (33.6%). The average age where the patient received antibiotics was 6.5 ± 5.3 compared to 7.8 ± 5.6 for patients who did not receive antibiotics (p < 0.001). Other demographics, including race, ethnicity, and Child Opportunity Index, were not significantly different between patients who received antibiotics or not. Overall, the total infection rate was 1.6%, including cellulitis, wound-related infections, respiratory infections, and other unspecified infections. The overall infection rate for patients receiving antibiotics was 1.9% compared to 1.5% for patients who did not receive antibiotics (p = 0.292). Patients who received antibiotics had a wound-related infection rate of 0.6% compared to 0.7% (p = 0.780).
Conclusions: The use of antibiotics did not have a significant impact on infection rates for pediatric nail bed injuries. Patients who received antibiotics had a younger mean age. Our study suggests limited clinical benefit of prophylactic antibiotics in pediatric nail bed injuries.
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