title: Prophylactic antibiotics for tube thoracostomy may not be appropriate in the developing world setting.
abstract: BACKGROUND
  Prophylactic antibiotics for tube thoracostomy (TT) for the prevention of post-traumatic empyema (PTE) remain controversial. Literature specifically focusing on the developing world setting is limited.
  
  
  METHODS
  A retrospective study was conducted over a four-year period on patients managed with TT alone in which prophylactic antibiotics was not utilised. We documented the actual incidence of PTE in a high volume trauma service in South Africa.
  
  
  RESULTS
  A total of 1002 patients who had TT in the trauma room were eligible for inclusion. Ninety-one percent (912/1002) were males and the mean age for all patients was 26 years (SD 7). Seventy-five percent (755/1002) sustained penetrating trauma (PT), while the remaining 25% (247/1002) sustained blunt trauma (BT). Six hundred and twenty patients (62%) sustained HTXs and the remaining 382 patients (38%) had PTXs. Of the 1002 patients who underwent TT, 15 (1.5%, 95% CI: 0.8-2.5%) developed PTE. The incidence of empyema in those with PT was 1.9% (14/755) and 0.4% (1/247) for BT. This difference was not statistically significant (p=0.166). All 15 patients who developed PTE were males, with a mean age of 31 years (SD 6). All 15 patients had HTX as the initial thoracic pathology. This difference was highly statistically significant when compared to PTX (p=0.002). The mean length of hospital stay was 11 days (SD 7). There were no mortalities in these patients.
  
  
  CONCLUSIONS
  In our setting where prophylactic antibiotics are not routinely used, the actual incidence of PTE in our population is extremely low. In the absence of further definitive evidence to support its use, routine prophylactic antibiotics for TT is difficult to justify in a developing world setting at present.
authors: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa. Electronic address: victorywkong@yahoo.com.
authors: Victor Y
authors: VY
authors: Kong
authors: Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa. Electronic address: sartorius@ukzn.ac.za.
authors: Benn
authors: B
authors: Sartorius
authors: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa. Electronic address: george.oost@gmail.com.
authors: George V
authors: GV
authors: Oosthuizen
authors: Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu Natal, Pietermaritzburg, South Africa. Electronic address: damianclar@gmail.com.
authors: Damian L
authors: DL
authors: Clarke
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D015505:Chest Tubes; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D011030:Pneumothorax / Q000628:therapy*; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D013898:Thoracic Injuries / Q000150:complications / Q000628:therapy*; D013907:Thoracostomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Developing world; Prophylactic antibiotics; Tube thoracostomy