Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention of empyema and pneumonia--a multi-center trial

J Trauma. 2004 Oct;57(4):742-8; discussion 748-9. doi: 10.1097/01.ta.0000147481.42186.42.


Objective: To determine whether presumptive antibiotics reduce the risk of empyema or pneumonia following tube thoracostomy for traumatic hemopneumothorax.

Methods: A prospective, randomized, double-blind trial was performed comparing the use of cefazolin for duration of tube thoracostomy placement (Group A) versus 24 hours (Group B) versus placebo (Group C).

Results: A total of 224 patients received 229 tube thoracostomies. Logistic regression analysis revealed that duration of tube placement and thoracic acute injury score were predictive of empyema (p <0.05). Empyema tended to occur more frequently in patients with penetrating injuries (p=0.09). chi analysis showed pneumonia occurred significantly more frequently in blunt than penetrating injuries (p <0.05). Presumptive antibiotic use did not significantly effect the incidence of empyema or pneumonia, although no empyemas occurred in Group A.

Conclusions: The incidence of empyema was low and the use of presumptive antibiotics did not appear to reduce the risk of empyema or pneumonia.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Antibiotic Prophylaxis*
  • Cefazolin / therapeutic use*
  • Chest Tubes
  • Device Removal
  • Double-Blind Method
  • Empyema, Pleural / prevention & control*
  • Female
  • Follow-Up Studies
  • Hemopneumothorax / etiology
  • Hemopneumothorax / physiopathology
  • Hemopneumothorax / surgery*
  • Humans
  • Injury Severity Score
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pneumonia, Bacterial / prevention & control*
  • Prospective Studies
  • Reference Values
  • Risk Assessment
  • Thoracic Injuries / complications
  • Thoracic Injuries / surgery
  • Thoracostomy / adverse effects*
  • Thoracostomy / methods
  • Trauma Centers
  • Treatment Outcome


  • Cefazolin