http://archsurg.jamanetwork.com/ en-us Wed, 01 May 2013 00:00:00 GMT Wed, 15 May 2013 15:46:30 GMT Silverchair editor@archsurg.jamanetwork.com webmaster@archsurg.jamanetwork.com http://archsurg.jamanetwork.com/article.aspx?articleID=1557238 Wed, 01 May 2013 00:00:00 GMT Oxman DA, Issa NC, Marty FM, et al. <span class="paragraphSection"><div class="boxTitle">Objective</div>To determine whether extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery with tube thoracostomy reduces the risk of infectious complications compared with preoperative prophylaxis only.<div class="boxTitle">Design</div>Prospective, randomized, double-blind, placebo-controlled trial.<div class="boxTitle">Setting</div>Brigham and Women's Hospital, an 800-bed tertiary care teaching hospital in Boston, Massachusetts.<div class="boxTitle">Participants</div>A total of 251 adult patients undergoing elective thoracic surgery requiring tube thoracostomy between April 2008 and April 2011.<div class="boxTitle">Interventions</div>Patients received preoperative antibacterial prophylaxis with cefazolin sodium (or other drug if the patient was allergic to cefazolin). Postoperatively, patients were randomly assigned (at a 1:1 ratio) using a computer-generated randomization sequence to receive extended antibacterial prophylaxis (n = 125) or placebo (n = 126) for 48 hours or until all thoracostomy tubes were removed, whichever came first.<div class="boxTitle">Main Outcome Measures</div>The combined occurrence of surgical site infection, empyema, pneumonia, and Clostridium difficile colitis by postoperative day 28.<div class="boxTitle">Results</div>A total of 245 patients were included in the modified intention-to-treat analysis (121 in the intervention group and 124 in the placebo group). Thirteen patients (10.7%) in the intervention group and 8 patients (6.5%) in the placebo group had a primary end point (risk difference, −4.3% [95% CI, −11.3% to 2.7%]; P = .26). Six patients (5.0%) in the intervention group and 5 patients (4.0%) in the placebo group developed surgical site infections (risk difference, −0.93% [95% CI, −6.1% to 4.3%]; P = .77). Seven patients (5.8%) in the intervention group and 3 patients (2.4%) in the placebo group developed pneumonia (risk difference, −3.4% [95% CI, −8.3% to 1.6%]; P = .21). One patient in the intervention group developed empyema. No patients experienced C difficile colitis.<div class="boxTitle">Conclusions</div>Extended postoperative antibacterial prophylaxis for patients undergoing elective thoracic surgery requiring tube thoracostomy did not reduce the number of infectious complications compared with preoperative prophylaxis only.<div class="boxTitle">Trial Registration</div>clinicaltrials.gov Identifier: NCT00818766</span> 148 5 440 446 10.1001/jamasurg.2013.1372 http://archsurg.jamanetwork.com/article.aspx?articleID=1557238 http://archsurg.jamanetwork.com/article.aspx?articleID=1557239 Wed, 01 May 2013 00:00:00 GMT Sanchez JA. <span class="paragraphSection">Many retrospective series conclude with the admonition that the findings should be corroborated by a well-designed, randomized clinical trial. With regard to the use of antibiotics following thoracic surgery, that study is now available. Oxman and colleagues provide us with a well-conducted, randomized study suggesting that routinely extending antimicrobial prophylaxis into the postoperative period is of no value in preventing infectious complications following thoracic surgery involving tube thoracostomy.</span> 148 5 447 447 10.1001/jamasurg.2013.1412 http://archsurg.jamanetwork.com/article.aspx?articleID=1557239