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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Are Prophylactic Antibiotics Necessary to Prevent Infections in Pediatric Nail Bed Injuries?
Lillia N Steffenson, BS; Kevin J. Little, MD; Ann R. Schwentker, MD
Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Introduction: Previous studies of tuft fractures in adults have demonstrated that prophylactic antibiotics provided no additional benefit in reducing infection rates. However, there are few studies evaluating the effectiveness of antibiotic prophylaxis in pediatric patients with tuft fractures, and evidence to date has been inconclusive. This retrospective study was conducted to determine the efficacy of antibiotic prophylaxis in the treatment of tuft fractures in pediatric patients.

Materials and Methods: A retrospective chart review was conducted of patients from 2010-2016. Patient details were collected from the electronic medical record with IRB approval. Inclusion criteria for participants were crush injury to fingertip, evaluation and treatment within 12 hours of injury, and at least one clinical follow up visit after three days. Exclusion criteria were existing antibiotic or steroid therapy at time of injury, bite injury to finger, or Seymour fracture. Antibiotic prophylaxis and rates of infection were compared between two groups of patients. Data was analyzed using descriptive statistics, FisherŐs exact test, relative risk, and odds ratio with 95% confidence intervals.

Results: 395 patients with a total of 416 crush injuries to the fingertip met inclusion criteria. There were 233 male and 162 female patients with a median age of 5 years (range 10 months to 20 years) Prophylactic antibiotics were prescribed in 84.3% of injuries. There were a total of 8 infections noted, with 5 out of 351 (1.4 %) cases treated with antibiotics and 3 out of 65 (4.6%) cases where antibiotics were not prescribed (p=0.114 FisherŐs exact test). The odds ratio for developing an infection without prophylactic antibiotics was 3.35 (95% CI (0.78-14.37)). Despite similar rates of antibiotics use between groups, there was no association between rate of infection and severity of the injury, identifiable fracture on radiographic imaging, or whether the injury occurred in a clean versus contaminated setting.

Conclusions: Antibiotic prophylaxis failed to significantly reduce the rate of infection in our sample, although there were fewer patients treated without antibiotics. Further, well-powered prospective studies are needed to fully evaluate the efficacy of antibiotic prophylaxis in pediatric patients.


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