O3263: Trends in the Use of Antibiotics for Open Forearm Fractures in Pediatric Patients

Background: Historically, there has been significant variability in antibiotic protocols for pediatric open fractures across different providers and institutions. Recent efforts have taken place to standardize treatment approaches. Still, there remains limited data on the widespread impacts of these efforts on altering clinical management or the need for further standardization. The purpose of this study was to assess the current practices and trends of antibiotic use for pediatric open fractures.

Methods: This was a retrospective review of the Pediatric Health Information System (PHIS) database from October 2015 to December 2023. The PHIS database houses extensive inpatient, emergency department, ambulatory, surgery, and observation encounter data from over 50 large, tertiary pediatric hospitals throughout the United States. Patients 18 years old or younger with an international classification of disease diagnosis code corresponding to an initial encounter open forearm fracture were included. The Gustilo-Anderson system was utilized to classify fracture severity. Descriptive statistics were used to characterize the population demographics and antibiotic selections. Fisher’s exact, Chi-squared, and Mann-Kendall tests were performed to analyze the antibiotic data.

Results: A total of 1224 patients were included in this study. The majority of patients had Type I or II fractures (97.2%) and did not receive surgical intervention (51.9%). When looking at all open fracture patients, at least one cephalosporin was given (95.7%) in almost every case, with cefazolin being the most utilized antibiotic by itself (92.9%). Type I or II open fracture patients received only cefazolin at a significantly higher rate compared to Type IIIA-C fracture patients, who more frequently received multiple cephalosporins (p = 0.003; Table 1). An aminoglycoside/penicillin or multiple additional antibiotics were added significantly more often for Type IIIA-C fractures than Type I or II fractures (p < 0.001). From 2015 to 2023, there were multiple significant trends suggesting the more consistent use of antibiotics for Type I or II open fracture patients (Figure 1). There were no significant trends found in antibiotic usage for Type IIIA-C fractures. No significant differences existed in antibiotic selection across hospital regions when evaluating all open fractures.

Conclusion: The standardization of antibiotic protocols for pediatric open fracture patients is crucial to ensure timely administration and improve patient care. In this study, we show that there is a recent improvement in adherence to the current antibiotic standard of care for Type I or II open fractures in pediatric patients. There may be sufficient regional standardization of general antibiotic selection for pediatric open fractures across the United States. However, 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 most optimal antibiotic protocol.