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Randomized Controlled Trial
. 2023 Apr;49(2):1113-1120.
doi: 10.1007/s00068-022-02163-y. Epub 2022 Nov 12.

No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial

Takio Teyi  1 , Joses Dany James  1 , Vivek Kumar  1 , Dinesh Bagaria  1 , Abhinav Kumar  1 , Narendra Choudhary  1 , Pratyusha Priyadarshini  1 , Amit Gupta  1 , Sushma Sagar  1 , Biplab Mishra  1 , Subodh Kumar  2
Affiliations
Randomized Controlled Trial

No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial

Takio Teyi et al. Eur J Trauma Emerg Surg. 2023 Apr.

Abstract

Purpose: To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC).

Methods: Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups.

Results: Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m CONCLUSION: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established.

Trial registry details: Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).

Keywords: Anti-microbial resistance; Inter-costal drain; Prophylactic antibiotic; Thoracic trauma.

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