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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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).

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Data availability

Data is available with the corresponding author and can be made available if required.

References

  1. WHO. The magnitude and causes of injuries. 2014. Available from: www.who.int/healthinfo/global_burden_disease/projections/en/accessed on 2.08.2021.

  2. Dandona L, Dandona R, Kumar GA, Shukla DK, Paul VK, Balakrishnan K, et al. Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study. Lancet. 2017;390(10111):2437–60.

    Google Scholar 

  3. Dandona R, Kumar GA, Gururaj G, James S, Chakma JK, Thakur JS, et al. Mortality due to road injuries in the states of India: the Global Burden of Disease Study 1990–2017. Lancet Public Heal. 2020;5(2):e86–98.

    Google Scholar 

  4. Zargar M, Khaji A, Karbakhsh DM. Thoracic injury: a review of 276 cases. Chin J Traumatol. 2007;10(5):259–62.

    PubMed  Google Scholar 

  5. Kumar DBA, Chakravarthy DGR, Bharath DA. Blunt trauma chest: a study on clinical pattern. IOSR J Dent Med Sci. 2017;16(3):1–7.

    CAS  Google Scholar 

  6. Narayanan R, Kumar S, Gupta A, Bansal VK, Sagar S, Singhal M, et al. An analysis of presentation, pattern and outcome of chest trauma patients at an urban level 1 trauma center. Indian J Surg. 2018;80(1):36–41.

    PubMed  Google Scholar 

  7. LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989;69(1):15–9. https://doi.org/10.1016/s0039-6109(16)44730-4.

    Article  PubMed  Google Scholar 

  8. Iyer S, Mansha S, Vinay J. Study of epidemiology and outcome of chest trauma at an apex tertiary care trauma centre. Int J of Surg. 2018;5(11):3621–6.

    Google Scholar 

  9. Millikan JS, Moore EE, Steiner E, Aragon GE, Van Way CW, IIIrd. Complications of tube thoracostomy for acute trauma. Am J Surg. 1980;140(6):738–41.

    CAS  PubMed  Google Scholar 

  10. Eddy AC, Luna GK, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg. 1989;157(5):494–7.

    CAS  PubMed  Google Scholar 

  11. Hoth JJ, Burch PT, Bullock TK, Cheadle WG, Richardson JD. Pathogenesis of posttraumatic empyema: The impact of pneumonia on pleural space infections. Surg Infect (Larchmt). 2003;4(1):29–35.

    PubMed  Google Scholar 

  12. Moore FO, Duane TM, Hu CK, Fox AD, McQuay N Jr, Lieber ML, Como JJ, Haut ER, Kerwin AJ, Guillamondegui OD, Burns JB. Eastern Association for the Surgery of Trauma. Presumptive antibiotic use in tube thoracostomy for traumatic hemopneumothorax: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S341–4.

    CAS  PubMed  Google Scholar 

  13. Holzheimer RG. Re: should we use routinely prophylactic antibiotics in patients with chest trauma? World J Surg. 2006;30(11):2080–1.

    CAS  PubMed  Google Scholar 

  14. Butler J, Sammy I, Desmond J, et al. Antibiotics in patients with isolated chest trauma requiring chest drains. Emergency Med J. 2002;19:553–4.

    Google Scholar 

  15. Gonzalez RP, Holevar MR. Role of prophylactic antibiotics for tube thoracostomy in chest trauma. Am Surg. 1998;64(7):617–20.

    CAS  PubMed  Google Scholar 

  16. 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;30(9):1148–53.

    PubMed  Google Scholar 

  17. Sanabria A, Valdivieso E, Gomez G, Echeverry G. Prophylactic antibiotics in chest trauma: a meta-analysis of high-quality studies. World J Surg. 2006;30(10):1843–7.

    PubMed  Google Scholar 

  18. Nichols RL, Smith JW, Muzik AC, Love EJ, McSwain NE, Timberlake G, Flint LM. Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracostomy. Chest. 1994;106(5):1493–8.

    CAS  PubMed  Google Scholar 

  19. Fontelles MJ, Mantovani M. Incidence of infectious complications following tube thoracostomy with and without use of antibiotic therapy: meta-analysis study. Acta Cir Bras. 2001;16(4):195–9.

    Google Scholar 

  20. Ayoub F, Quirke M, Frith D. Use of prophylactic antibiotic in preventing complications for blunt and penetrating chest trauma requiring chest drain insertion: a systematic review and meta-analysis. Trauma Surg Acute Care. 2019;4(1): e000246.

    Google Scholar 

  21. Cook A, Hu C. Ward J for the AAST Antibiotics in Tube Thoracostomy Study Group, et al Presumptive antibiotics in tube thoracostomy for traumatic hemopneumothorax: a prospective, Multicenter American Association for the Surgery of Trauma Study. Trauma Surg Acute Care. 2019;4: e000356.

    Google Scholar 

  22. Heydari MB, Hessami MA, Setayeshi K, Sajadifar F. Use of prophylactic antibiotics following tube thoracostomy for blunt chest trauma in the prevention of empyema and pneumonia. J Inj Violence Res. 2014;6(2):91–2.

    PubMed  PubMed Central  Google Scholar 

  23. Maxwell RA, Campbell DJ, Fabian TC, Croce MA, Luchette FA, Kerwin AJ, Davis KA, Nagy K, Tisherman S. Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia–a multi-center trial. J Trauma. 2004;57(4):742–8.

    CAS  PubMed  Google Scholar 

  24. Kong VY, Sartorius B, Oosthuizen GV, Clarke DL. Prophylactic antibiotics for tube thoracostomy may not be appropriate in the developing world setting. Injury. 2015;46(5):814–6.

    PubMed  Google Scholar 

  25. Pradeep G. Duration of prophylactic antibiotic in patient with intercostal chest drain. J IOSR-JDMS. 2018;17(4):28–31.

    Google Scholar 

  26. Chokshi A, Sifri Z, Cennimo D, Horng H. Global contributors to antibiotic resistance. J Glob Infect Dis. 2019;11(1):36–42.

    PubMed  PubMed Central  Google Scholar 

  27. Kotwani A, Holloway K. Antibiotic prescribing practice for acute, uncomplicated respiratory tract infections in primary care settings in New Delhi, India. Trop Med Int Health. 2014;19(7):761–8.

    PubMed  Google Scholar 

  28. Breijyeh Z, Jubeh B, Karaman R. Resistance of gram-negative bacteria to current antibacterial agents and approaches to resolve it. Molecules. 2020;25(6):1340.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Luchette FA, Barrie PS, Oswanski MF, Spain DA, Mullins CD, Palumbo F, Pasquale MD. Practice management guidelines for prophylactic antibiotic use in tube thoracostomy for traumatic hemopneumothorax: the EAST Practice Management Guidelines Work Group. Eastern Association for Trauma. J Trauma. 2000;48(4):753–7.

    CAS  PubMed  Google Scholar 

  30. Al-Koudmani I, Darwish B, Al-Kateb K, Taifour Y. Chest trauma experience over eleven-year period at al-mouassat university teaching hospital-Damascus: a retrospective review of 888 cases. J Cardiothorac Surg. 2012;7(35):42.

    Google Scholar 

  31. Mefire AC, Pagbe JJ, Fokou M, Nguimbous JF, Guifo ML, Bahebeck J. Analysis of epidemiology, lesions, treatment and outcome of 354 consecutive cases of blunt and penetrating trauma to the chest in an African setting. S Afr J Surg. 2010;48(3):90–3.

    PubMed  Google Scholar 

  32. WHO. Injuries and violence. 2021. Available from: https://www.who.int/newsroom/fact-sheets/detail/injuries-and-violence. Accessed on 10.08.21.

  33. Shorr RM, Crittenden M, Indeck M, Hartunian SL, Rodriguez A. Blunt thoracic trauma. Analysis of 515 patients. Ann Surg. 1987;206(2):200–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. Martínez Casas I, Amador Marchante MA, Paduraru M, Fabregues Olea AI, Nolasco A, Medina JC. Thorax trauma severity score: Is it reliable for patient’s evaluation in a secondary level hospital? Bull Emerg Trauma. 2016;4(3):150–5.

    PubMed  PubMed Central  Google Scholar 

  35. Hildebrand F, van Griensven M, Garapati R, et al. Diagnostics and scoring in blunt chest trauma. Eur J Trauma. 2002;28:157–67.

    Google Scholar 

  36. Chen J, Jeremitsky E, Philp F, Fry W, Smith RS. A chest trauma scoring system to predict outcomes. Surgery. 2014;156(4):988–93.

    PubMed  Google Scholar 

  37. Zahran MR, ElwahabAaema ENMMA, El Heniedy MA. Evaluation of the predictive value of thorax trauma severity score (TTSS) in thoracic-traumatized patients. Cardiothorac Surg. 2020;28(1):3.

    Google Scholar 

  38. Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. Comparison of injury severity score, new injury severity score, revised trauma score and trauma and injury severity score for mortality prediction in elderly trauma patients. Indian J Crit Care Med. 2019;23(2):73–7.

    PubMed  PubMed Central  Google Scholar 

  39. Aydogdu I, Sen N, Tuncer R, Fazli O, Keskin E, Okur H, et al. Comparison of trauma scoring systems in children with chest trauma. Bezmialem Sci. 2018;6(4):253–61.

    Google Scholar 

  40. Bosman A, De Jong MB, Debeij J, Van Den Broek PJ, Schipper IB. Systematic review and meta-analysis of antibiotic prophylaxis to prevent infections from chest drains in blunt and penetrating thoracic injuries. Br J Surg. 2012;99(4):506–13.

    CAS  PubMed  Google Scholar 

  41. Prunet B, Bourenne J, David JS, Bouzat P, Boutonnet M, Cordier PY, et al. Patterns of invasive mechanical ventilation in patients with severe blunt chest trauma and lung contusion: a French multicentric evaluation of practices. J Intensive Care Soc. 2019;20(1):46–52.

    PubMed  Google Scholar 

  42. Vassiliu P, Velmahos GC, Toutouzas KG. Timing, safety, and efficacy of thoracoscopic evacuation of undrained post-traumatic hemothorax. Am Surg. 2001;67(12):1165–9.

    CAS  PubMed  Google Scholar 

  43. Demirhan R, Onan B, Oz K, Halezeroglu S. Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interact Cardiovasc Thorac Surg. 2009;9(3):450–3.

    PubMed  Google Scholar 

  44. Jabaudon M, Blondonnet R, Constantin JM. ARDS in patients with chest trauma: better safe than sorry. Anaesth Crit Care Pain Med. 2019;38(3):221–2.

    PubMed  Google Scholar 

  45. Bell RL, Ovadia P, Abdullah F, Spector S, Rabinovici R. Chest tube removal: endinspiration or end-expiration? J Trauma. 2001;50(4):674–7.

    CAS  PubMed  Google Scholar 

  46. LoCurto JJ Jr, Tischler CD, Swan KG, Rocko JM, Blackwood JM, Griffin CC, Lazaro EJ, Reiner DS. Tube thoracostomy and trauma–antibiotics or not? J Trauma. 1986;26(12):1067–72.

    PubMed  Google Scholar 

  47. Mayberry JC, Trunkey DD. The fractured rib in chest wall trauma. Chest Surg Clin N Am. 1997;7(2):236–9.

    Google Scholar 

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Funding

No funding was received for conducting this study and the authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

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

    Takio Teyi, Joses Dany James, Vivek Kumar, Dinesh Bagaria, Abhinav Kumar, Narendra Choudhary, Pratyusha Priyadarshini, Amit Gupta, Sushma Sagar, Biplab Mishra & Subodh Kumar

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TT and SK. The first draft of the manuscript was written by JDJ, TT and VK. SK and other authors commented and edited previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Subodh Kumar.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval and trial registration

The study was approved by the institutional ethics committee and was registered with the Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019).

Informed consent

Written informed consent was obtained from all participants in the study.

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Teyi, T., James, J.D., Kumar, V. et al. No role of antibiotics in patients with chest trauma requiring inter-costal drain: a pilot randomized controlled trial. Eur J Trauma Emerg Surg 49, 1113–1120 (2023). https://doi.org/10.1007/s00068-022-02163-y

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