Article Figures & Data
Figures
- Figure 1
PRISMA flow diagram illustrating the literature search.
- Figure 2
Meta-analysis comparing antibiotics versus placebo in preventing (a) empyema and (b) pneumonia after chest drain insertion across all studies.
Tables
- Table 1
Characteristics of studies included in the meta-analysis of antibiotic vs placebo after chest drain insertion
Reference Year Country Sample size Injury type Antibiotic Duration Grover13 1977 USA 75 Penetrating Clindamycin 300 mg six hourly >24 hours Stone6 1981 USA 83 Penetrating, blunt Cefamandole 1 g six hourly >24 hours LeBlanc5 1985 USA 52 Penetrating, blunt Cefadyl 1 g >24 hours Mandal14 1985 USA 80 Penetrating Doxycycline 100 mg 12 hourly >24 hours LoCurto15 1986 USA 58 Penetrating, blunt Cefoxitin 1 g six hourly >24 hours Brunner20 1990 USA 90 Penetrating, blunt Cefazolin six hourly >24 hours Cant16 1993 South Africa 113 Penetrating Cefazolin 500 mg eight hourly 24 hours Nichols19 1994 USA 119 Penetrating, blunt Cefonicid 1 g per day >24 hours Gonzalez17 1998 USA 139 Penetrating, blunt Cefazolin 1 g eight hourly >24 hours Maxwell7 2004 USA 224 Penetrating, blunt Cefazolin 1 g eight hourly ≥24 hours Villegas Carlos18 2009 Mexico 126 Penetrating, blunt Cefazolin 1 g eight hourly >24 hours Heydari12 2014 Iran 104 Blunt Cefazolin 2 g 24 hours - Table 2
Primary outcomes
Study ID Antibiotic group Placebo group Total Empyema Pneumonia Total Empyema Pneumonia Grover13 38 1 4 37 6 13 Stone6 40 1 0 43 2 5 LeBlanc5 26 0 1 26 1 1 Mandal14 40 0 0 40 1 0 LoCurto15 30 0 0 28 5 4 Brunner20 44 0 1 46 6 3 Cant16 57 0 7 56 5 19 Nichols19 63 0 0 56 4 3 Gonzalez17 71 0 0 68 2 2 Maxwell7 153 2 12 71 4 2 Villegas Carlos18 63 3 N/A 63 5 N/A Heydari12 54 0 2 50 1 4 Total 679 7 (1%) 27 (4.4%) 584 42 (7.2%) 56 (10.7%) Values in parenthesis are percentages.
- Table 3
Secondary outcomes
Study ID Hospital stay (days) Duration of chest tube (days) Other outcomes Abx Placebo Abx Placebo Grover13 Shorter hospital stay N/A Abx: less fever, positive pleural fluid and wound cultures Stone6 8 10 6 Abx: lower positive pleural fluid and wound cultures LeBlanc5 N/A N/A Abx: less overall infections Mandal14 6.83 5.5 3.75 4.33 LoCurto15 6.6 10.3 5.4 3.8 Placebo: 5 thoracotomies for empyema Brunner20 5.2 8.3 4.1 7.2 Cant16 3.9 5.6 3.5 4.1 Similar positive pleural fluid cultures
Placebo: 5 thoracotomies for sepsisNichols19 6.3 7.2 4.9 5 Abx: less fever, WBC count
Placebo: 1 thoracotomy for empyemaGonzalez17 5.9 6.3 4.9 4.8 Abx: more chest tube reinsertion, pleural effusion Maxwell7 7.9 4.6 Villegas Carlos18 N/A 6.56 Heydari12 N/A 6.8 Hospital stay and duration of chest tube are presented in mean number of days.
Abx, antibiotics; WBC, white blood cells.
- Table 4
Summary of Cochrane risk of bias
Study ID Randomization Allocation concealment Blinding Incomplete data Outcome definition Grover13 Low Low Low Low Low Stone6 Unclear Unclear Low Low Low LeBlanc5 Unclear Unclear Unclear Low Low Mandal14 Low Low Unclear Low Low LoCurto15 High Unclear High Low Low Brunner20 High Unclear Unclear Low Low Cant16 Unclear Unclear Low Low Low Nichols19 Low Unclear Low Low Low Gonzalez17 Low Unclear Low Low Low Maxwell7 Unclear Low Low Low Low Villegas Carlos18 Unclear Unclear Low Low Low Heydari12 Unclear Unclear Unclear Low Low
Use of prophylactic antibiotic in preventing complications for blunt and penetrating chest trauma requiring chest drain insertion: a systematic review and meta-analysis
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