title: Postoperative antibacterial prophylaxis for the prevention of infectious complications associated with tube thoracostomy in patients undergoing elective general thoracic surgery: a double-blind, placebo-controlled, randomized trial.
abstract: OBJECTIVE
  To determine whether extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery with tube thoracostomy reduces the risk of infectious complications compared with preoperative prophylaxis only.
  
  
  METHODS
  Prospective, randomized, double-blind, placebo-controlled trial.
  
  
  METHODS
  Brigham and Women's Hospital, an 800-bed tertiary care teaching hospital in Boston, Massachusetts.
  
  
  METHODS
  A total of 251 adult patients undergoing elective thoracic surgery requiring tube thoracostomy between April 2008 and April 2011.
  
  
  METHODS
  Patients received preoperative antibacterial prophylaxis with cefazolin sodium (or other drug if the patient was allergic to cefazolin). Postoperatively, patients were randomly assigned (at a 1:1 ratio) using a computer-generated randomization sequence to receive extended antibacterial prophylaxis (n = 125) or placebo (n = 126) for 48 hours or until all thoracostomy tubes were removed, whichever came first.
  
  
  METHODS
  The combined occurrence of surgical site infection, empyema, pneumonia, and Clostridium difficile colitis by postoperative day 28.
  
  
  RESULTS
  A total of 245 patients were included in the modified intention-to-treat analysis (121 in the intervention group and 124 in the placebo group). Thirteen patients (10.7%) in the intervention group and 8 patients (6.5%) in the placebo group had a primary end point (risk difference, -4.3% [95% CI, -11.3% to 2.7%]; P = .26). Six patients (5.0%) in the intervention group and 5 patients (4.0%) in the placebo group developed surgical site infections (risk difference, -0.93% [95% CI, -6.1% to 4.3%]; P = .77). Seven patients (5.8%) in the intervention group and 3 patients (2.4%) in the placebo group developed pneumonia (risk difference, -3.4% [95% CI, -8.3% to 1.6%]; P = .21). One patient in the intervention group developed empyema. No patients experienced C difficile colitis.
  
  
  CONCLUSIONS
  Extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery requiring tube thoracostomy did not reduce the number of infectious complications compared with preoperative prophylaxis only.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00818766.
authors: Divisions of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, USA.
authors: David A
authors: DA
authors: Oxman
authors: Nicolas C
authors: NC
authors: Issa
authors: Francisco M
authors: FM
authors: Marty
authors: Alka
authors: A
authors: Patel
authors: Christia Z
authors: CZ
authors: Panizales
authors: Nathaniel N
authors: NN
authors: Johnson
authors: J Humberto
authors: JH
authors: Licona
authors: Shannon S
authors: SS
authors: McKenna
authors: Gyorgy
authors: G
authors: Frendl
authors: Steven J
authors: SJ
authors: Mentzer
authors: Michael T
authors: MT
authors: Jaklitsch
authors: Raphael
authors: R
authors: Bueno
authors: Yolonda
authors: Y
authors: Colson
authors: Scott J
authors: SJ
authors: Swanson
authors: David J
authors: DJ
authors: Sugarbaker
authors: Lindsey R
authors: LR
authors: Baden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000008:administration & dosage*; D015505:Chest Tubes; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013907:Thoracostomy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin