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.