Administer Antibiotics Before Placing a Chest Tube in Trauma Patients
Peter G. Thomas DO
Patrick K. Kim MD
The role of antibiotics during the placement of tube thoracostomy for hemothorax or pneumothorax in the trauma patient remains controversial. Every year, more than 100,000 chest tubes are placed in trauma patients for hemopneumothorax. Multiple studies have been performed over the last four decades to determine whether or not antibiotics decrease the rate of infection after chest-tube insertion.
In 2000, the Eastern Association for the Surgery of Trauma (EAST) Practice Management Guidelines Work Group reviewed all of the prospective articles and two meta-analyses on the topic published between 1977 and 1997. The group identified class I (prospective randomized controlled trials) and class II (clinical studies in which the data were collected prospectively, and retrospective analyses that were based on clearly reliable data) studies upon which to base their recommendations. The authors concluded that there is sufficient data to make a level III recommendation for prophylactic antibiotic use in patients undergoing tube thoracostomy for trauma. There is no apparent effect on empyema rate, but antibiotics may reduce the incidence of pneumonia. The guidelines suggest that antibiotics should not be given for more than 24 hours. The authors were able to make only level III recommendations (defined as “201C;supported by available data but adequate scientific evidence is lacking”) because the studies had markedly different study designs and treatment criteria, and as such, consensus conclusions could not be made based by combining the data.
Wilson and Nichols reviewed the same data and published an editorial to the EAST guidelines in 2000. Their interpretation of the data re-emphasized the correlation between the use of antibiotics during chest-tube placement and the decrease in the rate of pneumonia. When the three reviewed studies that had Centers for Disease Control and Prevention (CDC)–conforming criteria for pneumonia were combined, there was a 9.4% incidence of pneumonia for the placebo group and a 0.8% (p = 0.003) incidence for the antibiotic group. When the eight papers that compared antibiotics versus no antibiotics were combined, the pneumonia rate was 14.8% for the placebo group and 4.1% (p = 0.001) for the antibiotic group.