Olgac Guven, Aydogmus Umit, Mulazimoglu Lutfiye, Kutlu Cemal Asim
Department of Thoracic Surgery, Sureyyapasa Chest and Cardiovascular Diseases Teaching and Research Hospital, Istanbul, Turkey.
J Cardiothorac Surg. 2006 Nov 13;1:43. doi: 10.1186/1749-8090-1-43.
Usefulness of prophylactic antibiotics following tube thoracostomy remains controversial in the literature. In this study, we aimed to investigate the consequences of closed tube thoracostomy for primary spontaneous pneumothorax without the use of antibiotics.
One-hundred and nineteen patients underwent tube thoracostomy for primary spontaneous pneumothorax. None of them received prophylactic antibiotic treatment. Eight patients with prolonged air leak undergoing either video assisted thoracoscopic surgery or thoracotomy were excluded.
Of the remaining 111 (104 male and 7 female), 28 (25%) patients developed some induration around the entry site of chest tube that settled without further treatment. White blood cell count was high without any other evidence of infection in 12 (11%) patients and returned to its normal levels before discharge home in all. There was also some degree of fever not lasting for more than 48 hours in 8 (7%) patients. Bacterial cultures from suspected sites did not reveal any significant growth in these patients.
Prophylactic antibiotic treatment seems avoidable during closed tube thoracostomy for primary spontaneous pneumothorax. This policy was not only cost-effective but also prevented our patients from detrimental properties of unnecessary antibiotic use, such as development of drug resistance and undesirable side effects.
文献中对于胸腔闭式引流术后预防性使用抗生素的有效性仍存在争议。在本研究中，我们旨在探讨不使用抗生素进行原发性自发性气胸胸腔闭式引流的后果。
119例患者因原发性自发性气胸接受胸腔闭式引流。他们均未接受预防性抗生素治疗。8例持续漏气并接受电视辅助胸腔镜手术或开胸手术的患者被排除。
在其余111例患者（104例男性和7例女性）中，28例（25%）患者在胸管置入部位周围出现一些硬结，未经进一步治疗即自行消退。12例（11%）患者白细胞计数升高，但无任何其他感染证据，且在出院前均恢复至正常水平。8例（7%）患者还出现了程度不一的发热，但持续时间不超过48小时。这些患者可疑部位的细菌培养均未发现任何显著生长。
原发性自发性气胸胸腔闭式引流期间似乎可避免预防性抗生素治疗。这一策略不仅具有成本效益，还能使我们的患者避免不必要使用抗生素的有害影响，如耐药性的产生和不良副作用。
