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Antibiotic Usage and Infection Rates in Pediatric Fingertip Injuries: Analysis of the Pediatric Health Information System (PHIS) Database
Janet Hsu, BS, Alejandro J. Friedman, MA; Steven M. Koehler, M.D.
Montefiore Medical Center, Bronx, NY
Introduction: Pediatric patients are susceptible to many upper extremity injuries including fingertip injuries. The literature on antibiotic usage and subsequent infection rates in pediatric fingertip injuries is limited and lacks the power of database studies. The aim of this study is to examine how antibiotics affect infection rates in order to promote antibiotic stewardship while caring for fingertip injuries.
Materials & Methods: A retrospective study from January 2004 to December 2024 was done using the Pediatric Health Information System (PHIS) Database. The PHIS database is a database consisting of data from about 50 of the largest pediatric hospitals nationwide. Data was pulled for patients less than 18 years old who were treated in the emergency department using ICD-9 and ICD-10 codes for fingertip injuries, including open fractures, open wounds, and traumatic fingertip amputations. Demographics, antibiotic usage, and infection rates were analyzed. Descriptive statistics, Pearson's chi-squared test, and
t-tests were used for statistical analyses. Statistical significance was defined as a
p-value < 0.05.
Results: A total of 90834 patients from 45 hospitals were included (61.8% male, mean age 7.2 ± 5.1 years). Patients who received antibiotics had a mean age of 7.0 ± 5.1 years compared to 7.3 ± 5.1 years in patients without antibiotics
(p < 0.001)
. Gender was not associated with a significant difference in antibiotic usage. The overall infection rate was 1.4%. The infection rate in patients receiving antibiotics was 1.3% and 1.5% in patients who did not receive antibiotics (
p = 0.074). Patients receiving antibiotics had a wound-related infection rate of 0.4% compared with 0.5% in patients who did not receive antibiotics (
p = 0.041). Antibiotic usage did not result in a significant difference in rates of other infections.
Conclusions: Antibiotic usage did not affect the total infection rate significantly. However, pediatric patients who received antibiotics had significantly lower wound-related infection rates compared to patients who did not receive antibiotics for fingertip injuries. Though this relationship is statistically significant, it is not likely clinically significant. Given the power of this database study, the benefit of antibiotic use in pediatric patients for fingertip injuries is likely limited.
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