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Sat Nov 1 12:44:50 GMT 2008

BTW, what is the empyema rate for chest tubes placed in a resuscitative
setting? Or rate of pneumonia vs. pneumonia for similar ICU patients without
chest tubes? (Since you already did the work, so I won't have to, lol)

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Jeffrey Hammond
Sent: Saturday, November 01, 2008 1:19 AM
To: Trauma &amp; Critical Care mailing list
Cc: trauma-list at trauma.org
Subject: Re: Presumptive Antibiotic Administration And Chest Tube Insertion.

Agree with Dr Mattox...but...the problem is most of the papers have chosen
the wrong end-point to study. Empyema is such an uncommon event that, as Ken
points out, it would take a huge study to show a significant reduction.
However, we looked at this 5 or so years ago in an effort to develop an
internal consensus and there was literature that  suggested that antibiotic
administration with a 1st generation cepha-drug was associated with a lower
pneumonia rate. That has been our practice.

Jeffrey Hammond MD, MPH
New Brunswick, NJ

----- Original Message -----
From: KMATTOX at aol.com
Date: Friday, October 31, 2008 6:47 pm
Subject: Re: Presumptive Antibiotic Administration And Chest Tube Insertion.
To: trauma-list at trauma.org

> There is NO good data on EITHER side of this  
> question.     It would take 20 
> years and somewhere close to  500,000 cases to reach some sort of even 
> crude statistical power, because  empyema from an uncomplicated tube 
> thoracostomy is
> so incrediably  low.     
> So.........over time there has been an agreement that if one is to use 
> any antibiotic at all, it should be one that has minimal
> complications.    My own recommendation is the 
> CHEAPEST oral  FIRST GENERATION
> cephalosomething in your city's or hospital's  
> pharmacy.    NO, NO, NO, do not 
> sneak in a second generation  cephalosporin, or anything 
> any stronger.    It 
> simply in not  necessary.    
>  
> k
>  
>  
>  
>  
> In a message dated 10/31/2008 2:06:30 P.M. Central Daylight Time, 
> Richard.Ferraro at chw.edu writes:
>  
> Rick  Ferraro Trauma Program Manager Mercy San Juan Medical  Center
> 
> 
> 
> Question: I want to get feed back on your practice as it  
> pertains to one
> time antibiotic administration before chest tube insertion  
> for blunt or
> penetrating trauma. 
> 
> 
> 
> I hope this finds all  well!
> 
> 
> 
> 
> 
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Presumptive Antibiotic Administration And Chest Tube Insertion.