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Trends in the Use of Antibiotics for Open Forearm Fractures in Pediatric Patients From 2015 to 2023
Luke Sang1,2, Divij Sharma1, Michaela Booker1
1Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
Insights
Antibiotic use for pediatric open fractures shows improved adherence for less severe types, but variability persists for severe fractures. Further studies are needed to standardize treatment protocols for type IIIA-C pediatric open fractures.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Management
- Pharmacology
Background:
- Antibiotic prophylaxis is crucial for pediatric open fractures to prevent infection.
- Current guidelines recommend specific antibiotic regimens based on fracture severity.
- Practices may vary, necessitating an assessment of current antibiotic use trends.
Purpose of the Study:
- To evaluate contemporary antibiotic prescribing patterns for pediatric open fractures.
- To identify trends in antibiotic selection across different fracture severities (Gustilo-Anderson classification).
- To assess adherence to established standards of care in antibiotic prophylaxis.
Main Methods:
- Retrospective review of the Pediatric Health Information System database (October 2015 - December 2023).
- Inclusion of patients aged 18 years or younger with open forearm fractures.
- Analysis of antibiotic data using Fisher's exact, Chi-squared, and Mann-Kendall tests.
Main Results:
- A total of 1,224 pediatric patients were analyzed.
- Cephalosporins, primarily cefazolin, were used in 95.7% of cases.
- Type I/II fractures predominantly received single cefazolin (93.4%), while type IIIA-C fractures more often received multiple cephalosporins (11.8%) or additional antibiotics (8.8%).
- A significant increase in cephalosporin use and single antibiotic therapy was observed for type I/II fractures between 2015-2023 (P < .05).
Conclusions:
- Adherence to antibiotic standards of care has improved for pediatric type I/II open fractures.
- Variability in antibiotic selection for type IIIA-C pediatric open fractures persists, indicating a need for further standardization.
- Additional research is recommended to establish optimal antibiotic protocols for severe pediatric open fractures.
Background:
The purpose of this study was to assess the current practices and trends of antibiotic use for pediatric open fractures across varying severities.
Methods:
This was a retrospective review of the Pediatric Health Information System database from October 2015 to December 2023. Patients 18 years old or younger with an International Classification of Diseases diagnosis code corresponding to an initial encounter open forearm fracture were included in this study. The Gustilo-Anderson system was utilized to classify fracture severity. Fisher's exact, Chi-squared, and Mann-Kendall tests were used to analyze antibiotic data.
Results:
A total of 1,224 patients were included in this study. Most patients had type I or II fractures (97.2%) and did not receive surgical intervention (51.9%). A cephalosporin was administered to 95.7% of patients with open fractures, with cefazolin being the most utilized antibiotic (92.9%). Type I or II open fracture patients received only cefazolin at a significantly higher rate than type IIIA-C fracture patients (93.4% vs. 76.5%; P < .01), who more frequently received multiple cephalosporins (1.9% vs. 11.8%; P < .01). An aminoglycoside or penicillin, or multiple additional antibiotics were added significantly more often for type IIIA-C fractures than for type I or II fractures (4.4% vs. 8.8%; P < .01). Between 2015 and 2023, there was a significant increase in cephalosporins given to type I or II open fracture patients (P < .05). There was also an increasing trend of utilizing a single antibiotic for these patients (P < .05). No significant differences were found in antibiotic selection across hospital regions when evaluating all open fractures.
Conclusions:
In recent years, there has been an improvement in adherence to the current standard of care for antibiotic selection in pediatric type I or II open forearm fracture patients. However, variability still exists for type IIIA-C open fractures, suggesting the need for further standardization of antibiotic usage for these patients. Our findings highlight the need for additional studies to recommend the optimal antibiotic protocol in type IIIA-C pediatric open fractures.
Key Concepts:
(1)There has been recent improvement in adherence to the current antibiotic standard of care for type I or II open fractures in pediatric patients.(2)There may be sufficient regional standardization of general antibiotic selection for pediatric open fractures across the United States.(3)There is still variability for type IIIA-C open fractures, suggesting the need for further standardization in these cases and additional studies to recommend the optimal antibiotic protocol.
Level Of Evidence:
III, Retrospective Cohort Study.
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