There are 2 papers of significiance - one looked at antibiotic versus
placebo and founds reduced incidence of sepsis with anitbiotics.
Second from my old chief in South Africa looked at single dose proph
versus multiple doses and concluded that single dose as effective as
course of antibiotics.
Agree with point raised by Demetriades (now in LA) that early removal and
aggressive physio essential - certainly the cardiothoracics had a very
agressive policy of bronchosscopy if had not resolved after few days, to
suck out mucous plugs and "blow up" the lung, rather than "suck it up".
Anton
Staffordshire Ambulance Service
Am Surg 1998 Jul;64(7):617-20; discussion 620-1
Role of prophylactic antibiotics for tube thoracostomy in chest trauma.
Gonzalez RP, Holevar MR.
Department of Surgery, Christ Hospital and Medical Center, Oak Lawn,
Illinois 60453, USA.
The objective of this study was to evaluate the efficacy of antibiotic
prophylaxis in association with tube thoracostomy for chest trauma
patients with Injury Severity Scores of 9 or 10. A double-blind randomized
clinical trial of patients requiring tube thoracostomy was performed at an
urban Level 1 trauma center. All patients included in this series were
patients with Injury Severity Scores of 9 or 10 (hemothorax/pneumothorax)
who suffered isolated chest trauma secondary to blunt or penetrating
trauma. Before chest tube placement, 139 patients (34 blunt trauma, 105
penetrating trauma) were blindly randomized to Group A (71 patients) for
which they received 1 g cefazolin intravenously every 8 hours or Group B
(68 patients) for which they received a placebo intravenously every 8
hours. Antibiotic or placebo was administered before chest tube insertion
and continued until the time of chest tube removal. The majority of
patients underwent chest tube placement in the emergency room with a small
number of delayed pneumothoraces (4 patients) treated after admission. In
the 71 patients receiving antibiotic, 7 complications (1 pleural effusion,
2 chest tube reinsertions, 4 additional chest tubes) occurred, none of
which were infectious. In the 68 patients receiving placebo, 7
complications (2 empyemas, 2 pneumonias with effusions, 1 pleural
effusion, 2 chest tube reinsertions) occurred, 4 of which were infectious
and required antibiotic intervention (P = 0.05, Fisher's exact test). This
study showed that patients receiving antibiotics have a significantly
reduced incidence of infectious complications and suggests that patients
who undergo tube thoracostomy for chest trauma would benefit from
administration of prophylactic antibiotics.
Ann R Coll Surg Engl 1991 Nov;73(6):348-51
Antibiotic prophylaxis in penetrating injuries of the chest.
Demetriades D, Breckon V, Breckon C, Kakoyiannis S, Psaras G, Lakhoo M,
Charalambides D.
Department of Surgery, Baragwanath Hospital, South Africa.
Most prospective studies recommend antibiotic prophylaxis whilst a
thoracostomy tube is in place or even longer. We conducted a randomised
study of 188 patients with penetrating chest injuries requiring a chest
drain. Of these patients, 95 received a single dose of ampicillin before
insertion of the chest tube, the remaining 93 patients received additional
antibiotic prophylaxis for as long as the drain was in place. The
incidence of intrathoracic sepsis (pneumonia or empyema) was 3.1% and
3.2%, respectively. It is concluded that single-dose prophylaxis in
penetrating chest trauma is as effective as prolonged prophylaxis. The
importance of chest physiotherapy immediately after the drain insertion
and of early removal of the drain is stressed. The role of various
possible risk factors in the development of sepsis is discussed.
On Fri, 20 Apr 2001, Ray McGlone wrote:
> Probably not necessary. Last year I had a surgical SHO (hot foot from an
> ATLS course) who put a chest drain in without any sterile preparation. The
> patient didn't develop any infection.
>
> I'm not aware of any study on this one. What is the incidence of empyema?
>
> Ray McGlone
> A&E Lancaster
>
> ----- Original Message -----
> From: "Bill Bailey" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Saturday, April 21, 2001 3:37 AM
>
>
> > Re: Prophylactic antibiotics & Chest drains
> >
> > On the subject of prophylactic antibiotics, what do list members feel
> about
> > the administration of 1 shot of IV broad spectrum antibiotic just prior to
> > chest drain insertion [in trauma] to reduce the incidence of empyema?
> >
> > Bill Bailey
> > A&E Chesterfield
> >
>
|
