A Randomized Trial of Antimicrobial Prophylaxis in Patients Undergoing Medical Thoracoscopy (APT)

Abstract

Background: There is no data on the role of prophylactic antibiotics in patients undergoing medical thoracoscopy. Objective: In this study, we evaluated the efficacy and safety of a single dose of intravenous cefazolin in subjects undergoing medical thoracoscopy. Methods: Subjects undergoing medical thoracoscopy were randomized 1:1 to receive either intravenous cefazolin 2 g (antibiotic group) or intravenous saline (control group). The primary outcome was the incidence of infections (surgical site infections and empyema) in the study groups, while the secondary outcomes were complications related to intravenous antibiotics. Results: Of the 121 subjects screened, 100 (mean age ± SD: 52.2 ± 15.2 years; 38 [38%] women) were randomized to the study groups. The incidence of postprocedural infections was not different between the antibiotic and the control group (4 [8%] vs. 6 [12%], p = 0.28). Surgical site infection occurred in 1 subject (2%) in the antibiotic group and 3 subjects (6%) in the saline group (p = 0.62); empyema occurred in 3 subjects (6%) in each group (p = 1.00). There was no association between age, comorbid illness (diabetes mellitus or chronic kidney disease), study group allocation, type of thoracoscope used, duration of procedure, histological diagnosis (benign or malignant), and the occurrence of infections in the postprocedural period. Conclusion: The use of a single dose of cefazolin prior to medical thoracoscopy was not associated with a reduction in the occurrence of postprocedural infection.

Debugging: Is Routine Antimicrobial Prophylaxis Indicated in Medical Thoracoscopy?

“…The baseline characteristics and risk factors for infection, such as diabetes and chronic kidney disease, did not differ between the groups, and specifically were not different between patients who developed infection and those who did not [12] . Two deaths occurred in the study and appear to have been unrelated to infection.…”

“…In the present edition of Respiration , Dhooria and colleagues have made admirable inroads into gathering the evidence that we need [12] . They recruited patients who underwent diagnostic medical thoracoscopy without recent exposure to antimicrobials, randomised them to a single dose of 2 g intravenous cefazolin (a choice based on a surgical guideline) or placebo infusion prior to thoracoscopy, and analysed whether there was a significant difference in the rate of empyema or SSI between the groups.…”

Local Anaesthetic Thoracoscopy for Pleural Effusion—A Narrative Review

“…To mitigate against pleural space or skin infections, some centres routinely administer antibiotic prophylaxis [ 41 ]. However, there has been no demonstrable difference when Dhooria et al analysed the effect when patients received a single dose of antibiotic on infection rates [ 42 ]. Minor complications include subcutaneous emphysema, minor bleeding, peri-procedure hypotension as well as raised temperature and atrial fibrillation.…”

Infections in Invasive Pleural Procedures: A Single Centre Experience

“…Nuttal et al [7] have presented that prophylactic doxycycline following IPC insertion for malignant pleural effusions probably reduced their infection rate. More recently, Dhooria, et al [8] randomised 100 patients to receive either cefazolin or intravenous saline. The infection rate in the antibiotic group did not reduce, even after all the variables were controlled for.…”