title: Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia--a multi-center trial.
abstract: OBJECTIVE
  To determine whether presumptive antibiotics reduce the risk of empyema or pneumonia following tube thoracostomy for traumatic hemopneumothorax.
  
  
  METHODS
  A prospective, randomized, double-blind trial was performed comparing the use of cefazolin for duration of tube thoracostomy placement (Group A) versus 24 hours (Group B) versus placebo (Group C).
  
  
  RESULTS
  A total of 224 patients received 229 tube thoracostomies. Logistic regression analysis revealed that duration of tube placement and thoracic acute injury score were predictive of empyema (p <0.05). Empyema tended to occur more frequently in patients with penetrating injuries (p=0.09). chi analysis showed pneumonia occurred significantly more frequently in blunt than penetrating injuries (p <0.05). Presumptive antibiotic use did not significantly effect the incidence of empyema or pneumonia, although no empyemas occurred in Group A.
  
  
  CONCLUSIONS
  The incidence of empyema was low and the use of presumptive antibiotics did not appear to reduce the risk of empyema or pneumonia.
authors.affiliation: Department of Surgery, University Of Tennessee-Chattanooga Unit, Chattanooga, Tennessee, 37403, USA. MaxwellRA@erlanger.org
authors.forename: Robert A
authors.initials: RA
authors.lastname: Maxwell
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Campbell
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Fred A
authors.initials: FA
authors.lastname: Luchette
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerwin
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Davis
authors.forename: Kimberly
authors.initials: K
authors.lastname: Nagy
authors.forename: Samuel
authors.initials: S
authors.lastname: Tisherman
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000627:therapeutic use*; D015505:Chest Tubes; D020878:Device Removal; D004311:Double-Blind Method; D016724:Empyema, Pleural / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006468:Hemopneumothorax / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018410:Pneumonia, Bacterial / Q000517:prevention & control*; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D013898:Thoracic Injuries / Q000150:complications / Q000601:surgery; D013907:Thoracostomy / Q000009:adverse effects* / Q000379:methods; D014193:Trauma Centers; D016896:Treatment Outcome
chemical_list: D002437:Cefazolin