@article {Cooke000356, author = {Alan Cook and Chengcheng Hu and Jeanette Ward and Susan Schultz and Forrest O{\textquoteright}Dell Moore III and Geoffrey Funk and Jeremy Juern and David Turay and Salman Ahmad and Paola Pieri and Steven Allen and John Berne}, editor = {, and , and Funk, Geoffrey and Kugler, Nathan and Turay, David and Luo-Owen, Xian and Ahmad, Salman and Barnes, Stephen and Pieri, Paola and Allen, Steven and Berne, John and Kocik, Jurek and Allen, LaDonna and Cook, Alan and Nygaard, Rachel and Inaba, Kenji and Chouliaras, Konstantinos and Colonna, Alexander and Enniss, Toby and Michetti, Christopher and Griffen, Margaret and Ferrada, Paula and Han, Jinfeng and Hazelton, Joshua and Goldenberg, Anna and Haan, James and Lightwine, Kelly and Velmahos, George and Eid, Ahmed and Schultz, Susan and Flor, Remigio and Ward, Jeanette and Hu, Chengcheng and Moore, Forrest O and Taylor, Annette Ruiz and Wellard, Jeff and Graham, Lauren and Hu, Charles and Rogers, Fred and Vernon, Tawnya and Egan, Craig and Carrick, Matthew and Howley, Isaac and Gross, Ronald and Doben, Andrew and Paul, Douglas and Campbell, Melody and Upperman, Jeffrey and Kerwin, Andrew}, title = {Presumptive antibiotics in tube thoracostomy for traumatic hemopneumothorax: a prospective, Multicenter American Association for the Surgery of Trauma Study}, volume = {4}, number = {1}, elocation-id = {e000356}, year = {2019}, doi = {10.1136/tsaco-2019-000356}, publisher = {BMJ Specialist Journals}, abstract = {Background Thoracic injuries are common in trauma. Approximately one-third will develop a pneumothorax, hemothorax, or hemopneumothorax (HPTX), usually with concomitant rib fractures. Tube thoracostomy (TT) is the standard of care for these conditions, though TTs expose the patient to the risk of infectious complications. The controversy regarding antibiotic prophylaxis at the time of TT placement remains unresolved. This multicenter study sought to reconcile divergent evidence regarding the effectiveness of antibiotics given as prophylaxis with TT placement.Methods The primary outcome measures of in-hospital empyema and pneumonia were evaluated in this prospective, observational, and American Association for the Surgery of Trauma multicenter study. Patients were grouped according to treatment status (ABX and NoABX). A 1:1 nearest neighbor method matched the ABX patients with NoABX controls. Multilevel models with random effects for matched pairs and trauma centers were fit for binary and count outcomes using logistic and negative binomial regression models, respectively.Results TTs for HPTX were placed in 1887 patients among 23 trauma centers. The ABX and NoABX groups accounted for 14\% and 86\% of the patients, respectively. Cefazolin was the most frequent of 14 antibiotics prescribed. No difference in the incidence of pneumonia and empyema was observed between groups (2.2\% vs 1.5\%, p=0.75). Antibiotic treatment demonstrated a positive but non-significant association with risk of pneumonia (OR 1.61; 95\% CI: 0.86~3.03; p=0.14) or empyema (OR 1.51; 95\% CI: 0.42~5.42; p=0.53).Conclusion There is no evidence to support the routine use of presumptive antibiotics for post-traumatic TT to decrease the incidence of pneumonia or empyema. More investigation is necessary to balance optimal patient outcomes and antibiotic stewardship.Level of evidence II Prospective comparative study}, URL = {http://tsaco.smart01.highwire.org/content/4/1/e000356}, eprint = {http://tsaco.smart01.highwire.org/content/4/1/e000356.full.pdf}, journal = {Trauma Surgery \& Acute Care Open} }