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

Journal Article (Journal Article)

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 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.

Full Text

Duke Authors

Cited Authors

  • Freeman, JJ; Asfaw, SH; Vatsaas, CJ; Yorkgitis, BK; Haines, KL; Burns, JB; Kim, D; Loomis, EA; Kerwin, AJ; McDonald, A; Agarwal, S; Fox, N; Haut, ER; Crandall, ML; Como, JJ; Kasotakis, G

Published Date

  • 2022

Published In

Volume / Issue

  • 7 / 1

Start / End Page

  • e000886 -

PubMed ID

  • 36312819

Pubmed Central ID

  • PMC9608538

Electronic International Standard Serial Number (EISSN)

  • 2397-5776

Digital Object Identifier (DOI)

  • 10.1136/tsaco-2022-000886


  • eng

Conference Location

  • England