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. 2022 Oct 25;7(1):e000886.
doi: 10.1136/tsaco-2022-000886. eCollection 2022.

Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma

Jennifer J Freeman  1 , Sofya H Asfaw  2 , Cory J Vatsaas  3 , Brian K Yorkgitis  4 , Krista L Haines  3 , J Bracken Burns  5 , Dennis Kim  6 , Erica A Loomis  7 , Andy J Kerwin  4 , Amy McDonald  8 , Suresh Agarwal Jr  3 , Nicole Fox  9 , Elliott R Haut  10 , Marie L Crandall  4 , John J Como  11 , George Kasotakis  3
Affiliations

Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma

Jennifer J Freeman et al. Trauma Surg Acute Care Open. .

Abstract

Background: Antibiotic prophylaxis is routinely administered for most operative procedures, but their utility for certain bedside procedures remains controversial. We performed a systematic review and meta-analysis and developed evidence-based recommendations on whether trauma patients receiving tube thoracostomy (TT) for traumatic hemothorax or pneumothorax should receive antibiotic prophylaxis.

Methods: Published literature was searched through MEDLINE (via PubMed), Embase (via Elsevier), Cochrane Central Register of Controlled Trials (via Wiley), Web of Science and ClinicalTrials.gov databases by a professional librarian. The date ranges for our literature search were January 1900 to March 2020. A systematic review and meta-analysis of currently available evidence were performed using the Grading of Recommendations Assessment, Development and Evaluation methodology.

Results: Fourteen relevant studies were identified and analyzed. All but one were prospective, with eight being prospective randomized control studies. Antibiotic prophylaxis protocols ranged from a single dose at insertion to 48 hours post-TT removal. The pooled data showed that patients who received antibiotic prophylaxis were significantly less likely to develop empyema (OR 0.47, 95% CI 0.25 to 0.86, p=0.01). The benefit was greater in patients with penetrating injuries (penetrating OR 0.25, 95% CI 0.10 to 0.59, p=0.002, vs blunt OR 0.25, 95% CI 0.06 to 1.12, p=0.07). Administration of antibiotic prophylaxis did not significantly affect pneumonia incidence or mortality.

Discussion: In adult trauma patients who require TT insertion, we conditionally recommend antibiotic prophylaxis be given at the time of insertion to reduce incidence of empyema.

Prospero registration number: CRD42018088759.

Keywords: antibiotics; empyema; hemothorax; pneumothorax.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for study selection for analysis.
Figure 2
Figure 2
(A) Empyema: all trauma (prospective). (B) Empyema: all trauma (retrospective). (C) Funnel plot: empyema all trauma (prospective). (D) Risk of bias assessment.
Figure 3
Figure 3
(A) Empyema: penetrating trauma (prospective). (B) Empyema: blunt trauma (prospective).
Figure 4
Figure 4
(A) Pneumonia: all trauma (prospective). (B) Pneumonia: all trauma (retrospective). (C) Funnel plot: pneumonia all trauma.
Figure 5
Figure 5
(A) Mortality: all trauma (prospective). (B) Mortality: all trauma (retrospective). (C) Funnel plot: mortality all trauma.
Figure 6
Figure 6
GradePro table: empyema. *See Risk of Bias assessment. †Different antibiotics and different protocols used.
Figure 7
Figure 7
GradePro table: pneumonia and mortality. *See risk of bias assessment. †Different conclusions.
See this image and copyright information in PMC

References

    1. Broderick SR. Hemothorax. Thorac Surg Clin 2013;23:89–96. 10.1016/j.thorsurg.2012.10.003 - DOI - PubMed
    1. Meyer DM, Jessen ME, Wait MA, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial. Ann Thorac Surg 1997;64:1396–401. 10.1016/S0003-4975(97)00899-0 - DOI - PubMed
    1. Ramanathan R, Wolfe LG, Duane TM. Initial suction evacuation of traumatic hemothoraces: a novel approach to decreasing chest tube duration and complications. Am Surg 2012;78:883–7. 10.1177/000313481207800824 - DOI - PubMed
    1. Mowery NT, Gunter OL, Collier BR, Diaz JJ, Haut E, Hildreth A, Holevar M, Mayberry J, Streib E. Practice management guidelines for management of hemothorax and occult pneumothorax. J Trauma 2011;70:510–8. 10.1097/TA.0b013e31820b5c31 - DOI - PubMed
    1. Cook A, Hu C, Ward J, Schultz S, Moore Iii Forrest O'Dell, Funk G, Juern J, Turay D, Ahmad S, Pieri P, et al. . Presumptive antibiotics in tube thoracostomy for traumatic hemopneumothorax: a prospective, multicenter American association for the surgery of trauma study. Trauma Surg Acute Care Open 2019;4:e000356. 10.1136/tsaco-2019-000356 - DOI - PMC - PubMed

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