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Antibiotics in patients with isolated chest trauma requiring chest drains
  1. John Butler, Specialist Registrar,
  2. Ian Sammy, Consultant,
  3. Joel Desmond, Research Fellow,
  4. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether the administration of antibiotics reduces the incidence of intrathoracic infection in patients who have had a chest drain inserted after trauma. Altogether 321 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by John Butler, 
 Specialist RegistrarChecked by Ian Sammy, Consultant, and Joel Desmond , Research Fellow

    Clinical scenario

    A 25 year old man is stabbed in the chest during a pub brawl. He sustains an isolated chest injury that requires a tube thoracostomy. You wonder whether the administration of prophylactic antibiotics will reduce the incidence of intrathoracic infection in this patient.

    Three part question

    In [patients suffering isolated penetrating chest injuries which require tube thoracostomy] does [the administration of prophylactic antibiotics] reduce [the incidence of intrathoracic infection]?

    Search strategy

    Medline 1966 to 8/02 using the OVID interface. ({exp thoracic injuries OR chest injury.mp OR exp Chest tubes OR exp Thoracostomy OR chest drain.mp OR chest tube$.mp or thoracostomy.mp } AND {exp antibiotic prophylaxis OR antibiotic prophylaxis.mp OR exp antibiotics OR antibiotics.mp OR prophylactic antibiotics.mp}) LIMIT to human AND English.

    Search outcome

    Altogether 321 papers were found, of which 308 were irrelevant. One paper was a systematic review of 11 other relevant papers up to 1997 that were also found on our search. Only one other relevant paper was found after this date. Therefore the systematic review and the remaining paper are included in table 4.

    Table 4

    Comment(s)

    The EAST Practice Management Group have recently performed an excellent quality systematic review on this subject that included all other studies except Gonzalez et al. They give figures that show that the number needed to treat with antibiotics to prevent an intrathoracic infection is six. They caution that the available studies are small and these studies look at chest drains inserted under differing clinical situations and by differing grades of clinicians.

    ▸ CLINICAL BOTTOM LINE

    Administration of prophylactic antibiotics to patients requiring chest tube thoracostomy for isolated chest injuries reduces the incidence of intrathoracic infection especially empyema with an number needed to treat of six. The ideal regimen is 24 hours of a first generation cephalosporin.

    Report by John Butler, 
 Specialist RegistrarChecked by Ian Sammy, Consultant, and Joel Desmond , Research Fellow

    References

    View Abstract

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