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No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled

Takio Teyi¹, Joses Dany James¹, Vivek Kumar¹

¹Division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.

European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society

|November 12, 2022

Insights

Prolonged prophylactic antibiotic therapy (PAT) did not significantly reduce infectious complications in patients with blunt trauma chest (BTC) requiring inter-costal drains (ICDs). The study found low overall complication rates, questioning the definitive role of extended PAT in this patient group.

Area of Science:

Trauma Surgery
Infectious Disease Prevention
Critical Care Medicine

Background:

Inter-costal drains (ICDs) are crucial for managing blunt trauma chest (BTC) injuries.
Infectious complications associated with ICDs can increase patient morbidity and healthcare costs.
The role of prolonged prophylactic antibiotic therapy (PAT) in preventing these complications is not fully established.

Purpose of the Study:

To evaluate the efficacy of prolonged prophylactic antibiotic therapy (PAT) in preventing infectious complications related to inter-costal drain (ICD) insertion in patients with blunt trauma chest (BTC).

Main Methods:

A randomized controlled trial involving 120 adult patients with BTC requiring ICD insertion.
Patients were divided into two groups: one receiving prolonged PAT and the other receiving a single dose of antibiotics.
Exclusion criteria included penetrating injuries, need for mechanical ventilation, and immunocompromised status.

Main Results:

A low overall incidence of ICD-related infectious complications (pneumonia, empyema, surgical site infection) was observed in both groups.
No statistically significant difference in infectious complications was found between the prolonged PAT group and the no prolonged PAT group (p=0.500).
Secondary outcomes, including duration of ICD, length of hospital stay, and in-hospital mortality, also showed no significant differences between the groups.

Conclusions:

The prevalence of ICD-related infectious complications in blunt trauma chest patients is generally low.
Prolonged prophylactic antibiotic therapy does not appear to offer a definitive benefit in reducing infectious complications or associated morbidities in BTC patients with ICDs.
Further research may be needed to refine antibiotic strategies for specific high-risk subgroups.

Read full analysis

Abstract

Purpose:

To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC).

Methods:

Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups.

Results:

Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m CONCLUSION: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established.

Trial Registry Details:

Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).

Keywords:

Anti-microbial resistance Inter-costal drain Prophylactic antibiotic Thoracic trauma

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