Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracostomy.
OBJECTIVE
To evaluate the safety and effectiveness of antibiotics in reducing the infectious complications following closed tube thoracostomy for isolated chest trauma.


METHODS
Double-blind, randomized clinical trial.


METHODS
Medical school affiliated large urban teaching hospital and trauma center.


METHODS
One hundred nineteen of 159 patients over 18 years old presenting to the emergency department requiring closed tube thoracostomy for isolated chest injuries (113 penetrating, 6 blunt).


METHODS
Patients received either placebo or 1 g cefonicid daily intravenously started at chest tube insertion and stopped within 24 h of removal.


RESULTS
The development of wound infections, pneumonia (CDC criteria), or empyema; the incidence of adverse events; length of hospitalization. One nonspecific infection was seen in the cefonicid group (1.6 percent) and six respiratory tract infections (10.7 percent) in the placebo group (three empyema, one empyema with pneumonia, two pneumonia) (p = 0.0505; p = 0.0094 [excluding nonspecific infection]). No significant differences with antibiotic use were seen in the duration of chest tube use (p = 0.766), peak WBC counts (p = 0.108), lower peak temperatures (p = 0.063), or length of hospitalization (p = 0.165). Patients who developed infectious complications averaged approximately 8 days longer hospitalization than those without (p < 0.0001).


CONCLUSIONS
This study showed that patients receiving antibiotics had a significantly reduced rate of infection than did patients administered placebo. No significant adverse events were seen in either group.
Nichols
R L
RL
Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112-2699.
Smith
J W
JW
Muzik
A C
AC
Love
E J
EJ
McSwain
N E
NE
Timberlake
G
G
Flint
L M
LM
D000293:Adolescent; D000328:Adult; D015790:Cefonicid / Q000009:adverse effects / Q000627:therapeutic use*; D015505:Chest Tubes; D016009:Chi-Square Distribution; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000706:statistics & numerical data; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000517:prevention & control; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery*; D013907:Thoracostomy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000601:surgery*
D003692:Delayed-Action Preparations; D015790:Cefonicid