Location
LSU Health Sciences Center - New Orleans
Event Website
https://digitalscholar.lsuhsc.edu/surgery_s/
Document Type
Event
Start Date
4-5-2023 9:30 AM
End Date
4-5-2023 10:40 AM
Description
Introduction: Chest tube placement for pneumothorax or hemothorax is common in trauma patients. These are often associated with associated risk of empyema and pneumonia. The use of prophylactic antibiotics prior to tube thoracostomy for traumatic thoracic injuries is controversial. Previous authors have shown decreased incidence of empyema and pneumonia with presumptive use of antibiotics in patients undergoing tube thoracostomy for trauma. Other authors, however, have shown no benefit and even increased risk of antibiotic resistance and complications related to antibiotic use. The purpose of this study is to determine if prophylactic use of antibiotics for tube thoracostomy following trauma was associated with reduced rates of infection.
Methods: This study is a retrospective chart review of adult patients at a Level 1 Trauma Center from July 1, 2012-January 31, 2022 with thoracic injuries requiring tube thoracostomy. We identified 827 patients who underwent placement of a single chest tube. Of these patients, 36% received antibiotics prior to chest tube placement and 64% did not. We evaluated rates of infection and other complications. Pneumonia was defined by positive sputum cultures in conjunction with radiographic evidence. Empyema was defined based on positive pleural cultures.
Results: There was no significant difference in the rate of empyema (4.3% vs 4.2%, p=1.0) or pneumonia (17% vs 14.2% p=0.31) between the group that received antibiotics prior to tube thoracostomy and the group that did not receive antibiotics. There were significantly more patients with C. diff colitis in the antibiotics group (1.3% vs 0%, p=0.02). This group also had a significantly higher injury severity score, (20.7 vs 17, p=0.0001). Patients in the antibiotics group had significantly higher rates of sepsis (10.7% vs 5.1%, p=0.005), ICU admission (78.3% vs 46.1%, p=0.0001), intubation (29% vs 16.1%, p=0.0001), and longer hospital (16.5 vs 6.9, p=0.0001) and ICU length of stay (8.3 vs 6.7, p=0.006). However, the group that did not receive antibiotics had higher in-hospital mortality (33.2% vs 22.7%, p=0.002).
Conclusion: Prophylactic use of antibiotics prior to chest tube placement is not associated with decreased rates of infectious complications such as empyema or pneumonia and can have deleterious effects associated with their use such as increased risk of C. diff infections.
Recommended Citation
Brown, Morgan; Pavleszek, Katherine; Schroeder, Ryan; Schoen, Johnathan; Marr, Alan; Greiffenstein, Partick P.; Hunt, John; Stuke, Lance; and Smith, Alison, "Bug Juice and Chest Tubes: Are Prophylactic Antibiotics Needed for Tube Thoracostomy Placement?" (2023). Surgery Research Symposium. 10.
https://digitalscholar.lsuhsc.edu/surgery_s/2023/postera/10
Included in
Bug Juice and Chest Tubes: Are Prophylactic Antibiotics Needed for Tube Thoracostomy Placement?
LSU Health Sciences Center - New Orleans
Introduction: Chest tube placement for pneumothorax or hemothorax is common in trauma patients. These are often associated with associated risk of empyema and pneumonia. The use of prophylactic antibiotics prior to tube thoracostomy for traumatic thoracic injuries is controversial. Previous authors have shown decreased incidence of empyema and pneumonia with presumptive use of antibiotics in patients undergoing tube thoracostomy for trauma. Other authors, however, have shown no benefit and even increased risk of antibiotic resistance and complications related to antibiotic use. The purpose of this study is to determine if prophylactic use of antibiotics for tube thoracostomy following trauma was associated with reduced rates of infection.
Methods: This study is a retrospective chart review of adult patients at a Level 1 Trauma Center from July 1, 2012-January 31, 2022 with thoracic injuries requiring tube thoracostomy. We identified 827 patients who underwent placement of a single chest tube. Of these patients, 36% received antibiotics prior to chest tube placement and 64% did not. We evaluated rates of infection and other complications. Pneumonia was defined by positive sputum cultures in conjunction with radiographic evidence. Empyema was defined based on positive pleural cultures.
Results: There was no significant difference in the rate of empyema (4.3% vs 4.2%, p=1.0) or pneumonia (17% vs 14.2% p=0.31) between the group that received antibiotics prior to tube thoracostomy and the group that did not receive antibiotics. There were significantly more patients with C. diff colitis in the antibiotics group (1.3% vs 0%, p=0.02). This group also had a significantly higher injury severity score, (20.7 vs 17, p=0.0001). Patients in the antibiotics group had significantly higher rates of sepsis (10.7% vs 5.1%, p=0.005), ICU admission (78.3% vs 46.1%, p=0.0001), intubation (29% vs 16.1%, p=0.0001), and longer hospital (16.5 vs 6.9, p=0.0001) and ICU length of stay (8.3 vs 6.7, p=0.006). However, the group that did not receive antibiotics had higher in-hospital mortality (33.2% vs 22.7%, p=0.002).
Conclusion: Prophylactic use of antibiotics prior to chest tube placement is not associated with decreased rates of infectious complications such as empyema or pneumonia and can have deleterious effects associated with their use such as increased risk of C. diff infections.
https://digitalscholar.lsuhsc.edu/surgery_s/2023/postera/10