Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia--a multi-center trial.

Abstract

OBJECTIVE:

To determine whether presumptive antibiotics reduce the risk of empyema or pneumonia following tube thoracostomy for traumatic hemopneumothorax.

METHODS:

A prospective, randomized, double-blind trial was performed comparing the use of cefazolin for duration of tube thoracostomy placement (Group A) versus 24 hours (Group B) versus placebo (Group C).

RESULTS:

A total of 224 patients received 229 tube thoracostomies. Logistic regression analysis revealed that duration of tube placement and thoracic acute injury score were predictive of empyema (p <0.05). Empyema tended to occur more frequently in patients with penetrating injuries (p=0.09). chi analysis showed pneumonia occurred significantly more frequently in blunt than penetrating injuries (p <0.05). Presumptive antibiotic use did not significantly effect the incidence of empyema or pneumonia, although no empyemas occurred in Group A.

CONCLUSIONS:

The incidence of empyema was low and the use of presumptive antibiotics did not appear to reduce the risk of empyema or pneumonia.

• Authors: Robert A Maxwell, Donald J Campbell, Timothy C Fabian, Martin A Croce, Fred A Luchette, Andrew J Kerwin, Kimberly A Davis, Kimberly Nagy, Samuel Tisherman
• Journal: The Journal of trauma (J Trauma) Vol. 57 Issue 4 Pg. 742-8; discussion 748-9 (Oct 2004) ISSN: 0022-5282 [Print] United States
• PMID: 15514527 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Cefazolin

Topics

• Adolescent
• Adult
• Antibiotic Prophylaxis
• Cefazolin (therapeutic use)
• Chest Tubes
• Device Removal
• Double-Blind Method
• Empyema, Pleural (prevention & control)
• Female
• Follow-Up Studies
• Hemopneumothorax (etiology, physiopathology, surgery)
• Humans
• Injury Severity Score
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Pneumonia, Bacterial (prevention & control)
• Prospective Studies
• Reference Values
• Risk Assessment
• Thoracic Injuries (complications, surgery)
• Thoracostomy (adverse effects, methods)
• Trauma Centers
• Treatment Outcome