Ayoub Firas, Quirke Michael, Frith Daniel
Surgery, Queen Mary University of London, London, UK.
Trauma Surg Acute Care Open. 2019 Feb 22;4(1):e000246. doi: 10.1136/tsaco-2018-000246. eCollection 2019.
Chest drain insertion after chest trauma is often associated with high rate of complications. The use of prophylactic antibiotics in patients with blunt and penetrating chest trauma to prevent empyema and pneumonia after chest drain insertion has been debated.
To analyze the effectiveness of prophylactic antibiotics versus placebo to prevent complications in patients with blunt and penetrating chest injuries who require the insertion of a chest drain.
Pubmed, Embase, and grey literature databases were searched during May 2017 for randomized clinical trails comparing prophylactic antibiotic versus placebo in patients with chest injuries requiring chest drain insertion. Good quality randomized studies which met the inclusion criteria were assessed using the Cochrane Collaboration tool for assessing risk of bias and then were included in the systematic review. A meta-analysis of the included studies was concluded using Stata to analyze the relative risk of empyema and pneumonia in these patients.
The study identified 12 randomized studies that included 1263 patients with isolated blunt and penetrating chest trauma. The incidence of empyema after a chest drain insertion was 1% in the antibiotic group and 7.2% in the placebo group. The incidence of pneumonia after a chest drain insertion was 4.4% in the antibiotic group and 10.7% in the placebo group. The use prophylactic antibiotic in those patients was associated with a reduced risk of empyema (relative risk [RR] 0.25; 95% CI 0.13 to 0.49) and pneumonia (RR 0.41; 95% CI 0.24 to 0.71) after chest drain insertion when compared with placebo alone.
Prophylactic antibiotic administration in patients with penetrating and blunt chest injuries requiring the insertion of a chest drain was associated with a reduced risk for post-traumatic empyema and pneumonia. Further studies should evaluate the optimal type, dose, and duration of antibiotic given to patients with chest trauma requiring chest drain insertion.
胸部创伤后插入胸腔引流管常伴有高并发症发生率。对于钝性和穿透性胸部创伤患者，在插入胸腔引流管后使用预防性抗生素以预防脓胸和肺炎一直存在争议。
分析预防性抗生素与安慰剂在需要插入胸腔引流管的钝性和穿透性胸部损伤患者中预防并发症的有效性。
2017年5月检索了PubMed、Embase和灰色文献数据库，以查找比较预防性抗生素与安慰剂在需要插入胸腔引流管的胸部损伤患者中的随机临床试验。使用Cochrane协作工具评估符合纳入标准的高质量随机研究的偏倚风险，然后将其纳入系统评价。使用Stata对纳入研究进行荟萃分析，以分析这些患者发生脓胸和肺炎的相对风险。
该研究确定了12项随机研究，包括1263例单纯钝性和穿透性胸部创伤患者。抗生素组胸腔引流管插入后脓胸的发生率为1%，安慰剂组为7.2%。抗生素组胸腔引流管插入后肺炎的发生率为4.4%，安慰剂组为10.7%。与单独使用安慰剂相比，这些患者使用预防性抗生素与胸腔引流管插入后脓胸风险降低（相对风险[RR]0.25；95%CI 0.13至0.49）和肺炎风险降低（RR 0.41；95%CI 0.24至0.71）相关。
对于需要插入胸腔引流管的穿透性和钝性胸部损伤患者，预防性使用抗生素与创伤后脓胸和肺炎风险降低相关。进一步的研究应评估给予需要插入胸腔引流管的胸部创伤患者抗生素的最佳类型、剂量和疗程。
