title: Presumptive antibiotic use in tube thoracostomy for traumatic hemopneumothorax: an Eastern Association for the Surgery of Trauma practice management guideline.
abstract: BACKGROUND
  Antibiotic use in injured patients requiring tube thoracostomy (TT) to reduce the incidence of empyema and pneumonia remains a controversial practice. In 1998, the Eastern Association for the Surgery of Trauma (EAST) developed and published practice management guidelines for the use of presumptive antibiotics in TT for patients who sustained a traumatic hemopneumothorax. The Practice Management Guidelines Committee of EAST has updated the 1998 guidelines to reflect current literature and practice.
  
  
  METHODS
  A systematic literature review was performed to include prospective and retrospective studies from 1997 to 2011, excluding those studies published in the previous guideline. Case reports, letters to the editor, and review articles were excluded. Ten acute care surgeons and one statistician/epidemiologist reviewed the articles under consideration, and the EAST primer was used to grade the evidence.
  
  
  RESULTS
  Of the 98 articles identified, seven were selected as meeting criteria for review. Two questions regarding presumptive antibiotic use in TT for traumatic hemopneumothorax were addressed: (1) Do presumptive antibiotics reduce the incidence of empyema or pneumonia? And if true, (2) What is the optimal duration of antibiotic prophylaxis?
  
  
  CONCLUSIONS
  Routine presumptive antibiotic use to reduce the incidence of empyema and pneumonia in TT for traumatic hemopneumothorax is controversial; however, there is insufficient published evidence to support any recommendation either for or against this practice.
authors.affiliation: Division of Trauma and Surgical Critical Care, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA. moore677@aol.com
authors.forename: Forrest O
authors.initials: FO
authors.lastname: Moore
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.forename: Charles K C
authors.initials: CK
authors.lastname: Hu
authors.forename: Adam D
authors.initials: AD
authors.lastname: Fox
authors.forename: Nathaniel
authors.initials: N
authors.lastname: McQuay
authors.forename: Michael L
authors.initials: ML
authors.lastname: Lieber
authors.forename: John J
authors.initials: JJ
authors.lastname: Como
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerwin
authors.forename: Oscar D
authors.initials: OD
authors.lastname: Guillamondegui
authors.forename: J Bracken
authors.initials: JB
authors.lastname: Burns
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards*; D015505:Chest Tubes / Q000592:standards*; D016724:Empyema, Pleural / Q000517:prevention & control; D006468:Hemopneumothorax / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D006801:Humans; D011014:Pneumonia / Q000517:prevention & control; D013898:Thoracic Injuries / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013907:Thoracostomy / Q000379:methods / Q000592:standards*
chemical_list: D000900:Anti-Bacterial Agents