AT WHAT RISK OF EMPYEMA IS EMPIRIC ANTIBIOTIC-THERAPY JUSTIFIED IN TUBE THORACOSTOMY FOR TRAUMA

Although empiric antibiotic treatment may prevent the development of e mpyema following tube thoracostomy for isolated chest trauma, such tre atment has been questioned because empyema is an uncommon occurrence. Therefore, a threshold analysis was performed to determine the values of empyema risk and antibiotic efficacy above which empiric antibiotic therapy is warranted in tube thoracostomy for trauma. These threshold s and the 95% confidence bands above and below the threshold curve wer e estimated by Monte Carlo simulation. Comparison of published estimat es of empyema risk and drug efficacy with the estimated threshold show s that they lie well within the region favoring empiric antibiotic tre atment. For example, if antibiotics decrease the risk of empyema by a factor of four or greater, then any risk of empyema greater than 1-2% is great enough to justify treatment.