Use of prophylactic antibiotics following tube thoracostomy for blunt chest trauma in the prevention of empyema and pneumonia

Heydari, Mohammad Bagher; Hessami, Mohammad Ali; Setayeshi, Khosro; Sajadifar, Fatemeh

doi:10.5249/jivr.v6i2.11

Cited by 10 publications

(19 citation statements)

References 8 publications

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“…The included studies in this systematic review were all randomized clinical trails that compared the administration of prophylactic antibiotics versus placebo in patients with isolated chest injuries requiring chest drain insertion. All studies included male and female patients above the age of 12, except one study by Heydari et al 12 which included patients above the age of eight.…”

Section: Resultsmentioning

confidence: 99%

“…Specifically, nine studies included patients with both penetrating and blunt injuries together. Two studies13 14 included patients with penetrating chest injuries only, whereas one study12 focused on blunt injury only. Penetrating chest injuries were predominantly due to stabbing and gunshot wounds, whereas bunt chest injuries were due to a mixture of trauma including road traffic accidents.…”

Section: Resultsmentioning

confidence: 99%

“…The type of antibiotic and dose were different in some studies. Specifically, six studies used cefazolin,7 12 15–18 a first generation cephalosporin with broad bacterial coverage. The remainder of the included studies used clindamycin,13 cefamandole,6 cefadyl,5 doxycycline,14 cefoxitin,15 and cefonicid 19.…”

Section: Resultsmentioning

confidence: 99%

“…The dose of cefazolin was 2–3 g per 24 hours. In regards to the total duration of antibiotics, 10 studies involved antibiotic administration that exceeded 24 hours, whereas two studies12 16 administered antibiotics for 24 hours only. The overall antibiotic duration, for studies that administered antibiotics for more than 24 hours, lasted until the chest drain was removed.…”

Section: Resultsmentioning

confidence: 99%

“…This review concluded that pulmonary complications are less likely to develop in patients with penetrating chest trauma who received prophylactic antibiotic after chest drain insertion. Interestingly, we found only one study,12 published in the last 5 years that compared prophylactic antibiotic against placebo in patients with only blunt chest injuries. The latest EAST guidelines published in 2012 did not make recommendation for or against the use of prophylactic antibiotic for chest trauma patients after chest drain insertion.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Use of prophylactic antibiotic in preventing complications for blunt and penetrating chest trauma requiring chest drain insertion: a systematic review and meta-analysis

Ayoub

Quirke

Frith

2019

Trauma Surg Acute Care Open

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BackgroundChest drain insertion after chest trauma is often associated with high rate of complications. The use of prophylactic antibiotics in patients with blunt and penetrating chest trauma to prevent empyema and pneumonia after chest drain insertion has been debated.ObjectiveTo analyze the effectiveness of prophylactic antibiotics versus placebo to prevent complications in patients with blunt and penetrating chest injuries who require the insertion of a chest drain.MethodsPubmed, Embase, and grey literature databases were searched during May 2017 for randomized clinical trails comparing prophylactic antibiotic versus placebo in patients with chest injuries requiring chest drain insertion. Good quality randomized studies which met the inclusion criteria were assessed using the Cochrane Collaboration tool for assessing risk of bias and then were included in the systematic review. A meta-analysis of the included studies was concluded using Stata to analyze the relative risk of empyema and pneumonia in these patients.ResultsThe study identified 12 randomized studies that included 1263 patients with isolated blunt and penetrating chest trauma. The incidence of empyema after a chest drain insertion was 1% in the antibiotic group and 7.2% in the placebo group. The incidence of pneumonia after a chest drain insertion was 4.4% in the antibiotic group and 10.7% in the placebo group. The use prophylactic antibiotic in those patients was associated with a reduced risk of empyema (relative risk [RR] 0.25; 95% CI 0.13 to 0.49) and pneumonia (RR 0.41; 95% CI 0.24 to 0.71) after chest drain insertion when compared with placebo alone.ConclusionProphylactic antibiotic administration in patients with penetrating and blunt chest injuries requiring the insertion of a chest drain was associated with a reduced risk for post-traumatic empyema and pneumonia. Further studies should evaluate the optimal type, dose, and duration of antibiotic given to patients with chest trauma requiring chest drain insertion.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%