PREVENTIVE ANTIBIOTIC USAGE IN TRAUMATIC THORACIC INJURIES REQUIRING CLOSED TUBE THORACOSTOMY

Objective: To evaluate the safety and effectiveness of antibiotics in reducing the infectious complications following closed tube thoracosto my for isolated chest trauma. Design: Double-blind, randomized clinica l trial. Setting: Medical school affiliated large urban teaching hospi tal and trauma center. Patients: One hundred nineteen of 159 patients over 18 years old presenting to the emergency department requiring clo sed tube thoracostomy for isolated chest injuries (113 penetrating, 6 blunt). Intervention: Patients received either placebo or Ig cefonicid daily intravenously started at chest tube insertion and stopped withi n 24 h of removal. Measurements and results: The development of wound infections, pneumonia (CDC criteria), or empyema; the incidence of adv erse events; length of hospitalization. One nonspecific infection was seen in the cefonicid group (1.6 percent) and six respiratory tract in fections (10.7 percent) in the placebo group (three empyema, one empye ma with pneumonia, two pneumonia) (p=0.0505; p=0.0094 [excluding nonsp ecific infection]). No significant differences with antibiotic use wer e seen in the duration of chest tube use (p=0.766), peak WBC counts (p =0.108), lower peak temperatures (p=0.063), or length of hospitalizati on (p=0.165). Patients who developed infectious complications averaged approximately 8 days longer hospitalization than those without (p<0.0 001). Conclusion: This study showed that patients receiving antibiotic s had a significantly reduced rate of infection than did patients admi nistered placebo. Nd significant adverse events were seen in either gr oup.