Felipe Villegas-Carlos, Vázquez-Martínez AM, Pinedo-Onofre JA, Guevara-Torres L, Belmares-Taboada JA, Sánchez-Aguilar M

Language: Spanish
References: 23
Page: 29-32
PDF size: 85.77 Kb.

ABSTRACT

Background: Thoracic trauma accounts for 25% of deaths due to trauma. Chest trauma patients generally present to the emergency room with pneumo- or hemothorax. According to the majority of the studies, management of closed thoracostomy for trauma includes the use of antimicrobial drugs to prevent infectious complications, but this has not been proven to be beneficial. We undertook this study to evaluate antimicrobial use in thoracic trauma patients with closed thoracostomy and its impact on the development of infectious complications.
Methods: We carried out a prospective, randomized, doubleblind, comparative study. Patients with isolated chest trauma requiring closed thoracostomy were divided into two groups. Group A received cefalotin, and group B received placebo. Ages ranged from 15-65 years. Results were analyzed with χ2 and Fisher exact test.
Results: One hundred twenty six patients were included in this study. There were 63 patients in each group with similar demographic characteristics. The mean length of hospital stay with the tube was 6.56 days, but the average stay was 11 days for patients who developed empyema. Eight patients developed empyema, three patients with empyema belonged to group A patients and five patients with empyema belonged to group B. For empyema management, five cases were resolved by chest drainage, two cases required thoracoscopic cleaning and drainage and one patient was resolved with thoracotomy and pleural decortication. Bivariate analysis comparing antimicrobial use vs. empyema and length of drainage vs. antimicrobials did not show a statistically significant difference.
Conclusions: The present study did not demonstrate that antimicrobial use was beneficial in the prevention of pleural infections in the management of chest trauma patients requiring closed thoracostomy.

REFERENCES

1. Mackenzie E, Fowler C, Moore E, Feliciano D, Mattox K. Epidemiología. En: Trauma, Quinta edición. México: McGraw-Hill; 2004.

2. Instituto Nacional de Estadística, Geografía e Informática. Estadísticas en mortalidad. Disponible en http://www.inegi.gob.mx/est/contenidos/espanol/ proyectos/continuas/vitales/bd/mortalidad/MortalidadGeneral. asp?s=est&c=11144

3. Symbas PN. Cardiothoracic trauma. Curr Probl Surg 1991;28:741-797.

4. 4.Kemmer WT, Eckert WJ, Gathwright JB, Reemtsma K, Creech O Jr. Patterns of thoracic injuries in fatal traffic accidents. J Trauma 1961;1-595. 5. Luchette FA, Barrie PS, Oswanski MF, Spain DA, Mullins CD, Palumbo F, et al. Practice management guidelines for prophylactic antibiotic used in tube thoracostomy for traumatic hemopenumothorax: The EAST practice management guidelines work group. Eastern Association for Trauma. J Trauma 2000;48:753-757.

5. 6.Hoff SJ, Shotts SD, Eddy VA, Morris JA Jr. Outcome of isolated pulmonary contusion in blunt trauma patients. Am Surg 1994;69:138-142.

6. Allen GS, Cox CS Jr. Pulmonary contusion in children: diagnosis in management. South Med J 1998;91:1099-1106.

7. Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg 1989;157:494-497.

8. LeBlanc KA, Tucker WY. Prophylactic antibiotics and closed tube thoracostomy. Surg Gynecol Obstet 1985;160:259-263.

9. Nichols RL, Smith WJ, Muzik AC, Love EJ, McSwain NE, Timberlake G, et al. Preventive antibiotics usage in traumatic thoracic injuries requiring closed tube thoracostomy. Chest 1994;106:1493-1498.

10. 11.Mandal AK, Thadepalli H, Mandal AK, Chetipalli U. Posttraumatic empyema thoracis: 24-year-experience at a major trauma center. J Trauma 1997;43:764-771.

11. Stewart KC, Urschel JD, Nakai SS, Gelfand ET, Hamilton SM. Pulmonary resection for lung trauma. Ann Thorac Surg 1997;63:1587-1588.

12. LoCurto JJ Jr, Tischeler CD, Swan KG, Rocko JM, Blackwood JM, Griffin CC, et al. Tube thoracostomy and trauma: antibiotics or not. J Trauma 1986;26:1067-1072.

13. González RP, Holevar MR, Scholten DJ, Chendrasekhar A. Role of prophylactic antibiotics for tube thoracostomy in chest trauma. Am Surg 1998;64:617-621.

14. Richardson JD, Miller FB, Carrillo EH, Spain DA. Complex thoracic injuries. Surg Clin North Am 1996;76:725-750.

15. Brunner RG, Vinsant GO, Alexander RH, Laneve L, Fallon WF Jr. The role of antibiotic therapy in the prevention of empyema in patients with an isolated chest injury (ISS 9-10): a prospective study. J Trauma 1990;3:1148-1154.

16. Mandal AK, Montano J, Thadenpalli H. Prophylactic antibiotics and no antibiotics compared in penetrating chest trauma. J Trauma 1985;25:639-643.

17. 18.Wilson RF, Nichols RL. The EAST practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax: a commentary. Eastern Asociation for Trauma. J Trauma 2000;48:758-759.

18. Grover FL, Richardson JD, Fewel JG, Arom KV, Webb GE, Trinkle JK. Prophylactic antibiotics in the treatment of penetrating chest wounds. J Thoracic Cardiovasc Surg 1977;74:528-536.

19. Aufmkolk M, Fischer R, Voggenreiter G, Kleinschmidt C, Schmit-Neuerburg KP, Obertacke U. Local effect of lung contusion on lung surfactant composition in multiple trauma patients. Crit Care Med 1999;27:1441-1446.

20. Mangran AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:247-278.

21. Sande M, Eliopoulos G, Moellering R, Gilbert D. The Sanford Guide to Antimicrobial Therapy. Madrid: Trigesima;2006.

22. Cant PJ, Smyth S, Smart DO. Antibiotic prophylaxis is indicated for chest stab wounds requiring closed tube thoracostomy. Br J Surg 1993;80:464-466.

23. Maxwell RA, Campbell DJ, Fabian TC, Croce MA, Luchette FA, Kerwin AJ, et al. Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia—a multi-center trial. J Trauma 2004;10:742-749.