Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma
Background Antibiotic prophylaxis is routinely administered for most operative procedures, but their utility for certain bedside procedures remains controversial. We performed a systematic review and meta-analysis and developed evidence-based recommendations on whether trauma patients receiving tube...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/7/1/e000886.full |
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| author | Marie L Crandall Elliott R Haut John J Como Dennis Kim George Kasotakis Brian K Yorkgitis Amy McDonald Jennifer J Freeman Sofya H Asfaw Cory J Vatsaas Krista L Haines J Bracken Burns Erica A Loomis Andy J Kerwin Suresh Agarwal, Nicole Fox |
| author_facet | Marie L Crandall Elliott R Haut John J Como Dennis Kim George Kasotakis Brian K Yorkgitis Amy McDonald Jennifer J Freeman Sofya H Asfaw Cory J Vatsaas Krista L Haines J Bracken Burns Erica A Loomis Andy J Kerwin Suresh Agarwal, Nicole Fox |
| author_sort | Marie L Crandall |
| collection | DOAJ |
| description | Background Antibiotic prophylaxis is routinely administered for most operative procedures, but their utility for certain bedside procedures remains controversial. We performed a systematic review and meta-analysis and developed evidence-based recommendations on whether trauma patients receiving tube thoracostomy (TT) for traumatic hemothorax or pneumothorax should receive antibiotic prophylaxis.Methods Published literature was searched through MEDLINE (via PubMed), Embase (via Elsevier), Cochrane Central Register of Controlled Trials (via Wiley), Web of Science and ClinicalTrials.gov databases by a professional librarian. The date ranges for our literature search were January 1900 to March 2020. A systematic review and meta-analysis of currently available evidence were performed using the Grading of Recommendations Assessment, Development and Evaluation methodology.Results Fourteen relevant studies were identified and analyzed. All but one were prospective, with eight being prospective randomized control studies. Antibiotic prophylaxis protocols ranged from a single dose at insertion to 48 hours post-TT removal. The pooled data showed that patients who received antibiotic prophylaxis were significantly less likely to develop empyema (OR 0.47, 95% CI 0.25 to 0.86, p=0.01). The benefit was greater in patients with penetrating injuries (penetrating OR 0.25, 95% CI 0.10 to 0.59, p=0.002, vs blunt OR 0.25, 95% CI 0.06 to 1.12, p=0.07). Administration of antibiotic prophylaxis did not significantly affect pneumonia incidence or mortality.Discussion In adult trauma patients who require TT insertion, we conditionally recommend antibiotic prophylaxis be given at the time of insertion to reduce incidence of empyema.PROSPERO registration number CRD42018088759. |
| format | Article |
| id | doaj-art-9e2f86a6028a4e13b4d709bea9dae6f7 |
| institution | DOAJ |
| issn | 2397-5776 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-9e2f86a6028a4e13b4d709bea9dae6f72025-08-20T02:48:43ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762022-10-017110.1136/tsaco-2022-000886Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of TraumaMarie L Crandall0Elliott R Haut1John J Como2Dennis Kim3George Kasotakis4Brian K Yorkgitis5Amy McDonald6Jennifer J Freeman7Sofya H Asfaw8Cory J Vatsaas9Krista L Haines10J Bracken Burns11Erica A Loomis12Andy J Kerwin13Suresh Agarwal,14Nicole Fox15Department of Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USADepartments of Surgery, Anesthesiology and Critical Care Medicine, and Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USADepartment of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA6 Surgical Critical Care, Los Angeles County Harbor–UCLA Medical Center, Torrance, California, USA2 Division of Trauma and Acute Care Surgery, Inova Fairfax Hospital, Falls Church, Virginia, USASurgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA11 Neurology, Royal Melbourne Hospital, Parkville, Victoria, Adelaide, AustraliaDepartment of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, Texas, USA2 General Surgery, Cleveland Clinic, Cleveland, Ohio, USA3 Surgery, Duke University School of Medicine, Durham, North Carolina, USA3 Surgery, Duke University School of Medicine, Durham, North Carolina, USA5 Surgery, East Tennessee State University, Johnson City, Tennessee, USA7 Surgery, Mayo Clinic, Rochester, Minnesota, USA4 Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA3 Duke University Medical Center, Durham, North Carolina, USACooper University Health Care, Camden, New Jersey, USABackground Antibiotic prophylaxis is routinely administered for most operative procedures, but their utility for certain bedside procedures remains controversial. We performed a systematic review and meta-analysis and developed evidence-based recommendations on whether trauma patients receiving tube thoracostomy (TT) for traumatic hemothorax or pneumothorax should receive antibiotic prophylaxis.Methods Published literature was searched through MEDLINE (via PubMed), Embase (via Elsevier), Cochrane Central Register of Controlled Trials (via Wiley), Web of Science and ClinicalTrials.gov databases by a professional librarian. The date ranges for our literature search were January 1900 to March 2020. A systematic review and meta-analysis of currently available evidence were performed using the Grading of Recommendations Assessment, Development and Evaluation methodology.Results Fourteen relevant studies were identified and analyzed. All but one were prospective, with eight being prospective randomized control studies. Antibiotic prophylaxis protocols ranged from a single dose at insertion to 48 hours post-TT removal. The pooled data showed that patients who received antibiotic prophylaxis were significantly less likely to develop empyema (OR 0.47, 95% CI 0.25 to 0.86, p=0.01). The benefit was greater in patients with penetrating injuries (penetrating OR 0.25, 95% CI 0.10 to 0.59, p=0.002, vs blunt OR 0.25, 95% CI 0.06 to 1.12, p=0.07). Administration of antibiotic prophylaxis did not significantly affect pneumonia incidence or mortality.Discussion In adult trauma patients who require TT insertion, we conditionally recommend antibiotic prophylaxis be given at the time of insertion to reduce incidence of empyema.PROSPERO registration number CRD42018088759.https://tsaco.bmj.com/content/7/1/e000886.full |
| spellingShingle | Marie L Crandall Elliott R Haut John J Como Dennis Kim George Kasotakis Brian K Yorkgitis Amy McDonald Jennifer J Freeman Sofya H Asfaw Cory J Vatsaas Krista L Haines J Bracken Burns Erica A Loomis Andy J Kerwin Suresh Agarwal, Nicole Fox Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma Trauma Surgery & Acute Care Open |
| title | Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma |
| title_full | Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma |
| title_fullStr | Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma |
| title_full_unstemmed | Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma |
| title_short | Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma |
| title_sort | antibiotic prophylaxis for tube thoracostomy placement in trauma a practice management guideline from the eastern association for the surgery of trauma |
| url | https://tsaco.bmj.com/content/7/1/e000886.full |
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