UMEM Educational Pearls

Category: Trauma

Title: Should we be giving antibiotics prior to or after chest tube insertion

Keywords: chest tube, antibiotics, tube thoracotomy, prophylaxis, meta-analysis, EAST (PubMed Search)

Posted: 1/15/2023 by Robert Flint, MD (Updated: 2/4/2023)
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A systemic review and meta-analysis revealed that the literature and science surrounding timing and effectiveness of prophlactic antibiotic use in tube thoracotomy for trauma is not robust.  The heterogeneity of the antibiotics used, the duration of antibiotics and the nature of the trauma (majority penetrating) make it very difficult to give an iron clad recommendation. The authors conclusion, which is the practice management guideline from the Eastern Association for the Surgery of Trauma, ultimately was:

 

“We conditionally recommend that antibiotic prophylaxis be given at the time of insertion to reduce empyema in adult patients who require TT for traumatic hemothorax or pneumothorax.”

References

Jennifer J Freeman Sofya H Asfaw, Cory J Vatsaas, Brian K Yorkgitis, Krista L HaineJ Bracken Burns, Dennis Kim, Erica A Loomi, Andy J Kerwin, Amy McDonald, Suresh Agarwal, Jr., Nicole Fox Elliott R Haut, Marie L Crandall, John J Como George Kasotakis

 

Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma

Trauma Surgery and Acute Care Open 2022 Volume 7, Issue 1