What is the recommended treatment for secondary infection in hemothorax?

From the Guidelines

The recommended treatment for secondary infection in hemothorax involves prompt administration of broad-spectrum antibiotics, typically including coverage for both gram-positive and gram-negative organisms, as well as complete drainage of the infected hemothorax.

Key Considerations

• Initial empiric therapy often includes a combination of antibiotics that cover community-acquired bacterial pathogens and anaerobic organisms, such as a second-generation cephalosporin (e.g., cefuroxime) or an aminopenicillin (e.g., amoxycillin), with the addition of a beta-lactamase inhibitor or metronidazole 1.
• The choice of antibiotics should be guided by bacterial culture results when possible, and hospital-acquired empyema requires broader spectrum antibiotic cover 1.
• Complete drainage of the infected hemothorax is essential, typically through chest tube thoracostomy or video-assisted thoracoscopic surgery (VATS) for loculated collections, and surgical debridement may be necessary for organized infections or if fibrinolytic therapy fails to break up loculations.
• Supportive care including pain management, respiratory support, and nutritional optimization is also important, as infected hemothorax can rapidly progress to empyema or sepsis, with the confined blood collection serving as an ideal medium for bacterial growth, particularly common pathogens like Staphylococcus aureus, Streptococcus species, and gram-negative organisms.

Recent Guidelines

• The 2023 WSES guidelines on the management of trauma in elderly and frail patients suggest that presumptive antibiotic use in thoracostomy has a clear role in preventing infectious complications in chest trauma patients, particularly in penetrating injuries 1.
• However, the optimal type, dose, and duration of antibiotic administration in thoracic trauma patients and in the elderly require further studies to be defined 1.

Antibiotic Therapy

• Antibiotic therapy should be started as soon as pleural infection is identified, and the chosen regimen should reflect local hospital policy and whether the infection was contracted in the community or in hospital 1.
• Aminoglycosides should be avoided due to poor penetration into the pleural space and potential inactivity in the presence of pleural fluid acidosis 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment for Secondary Infection in Hemothorax

The treatment for secondary infection in hemothorax involves the use of antibiotics and proper chest tube management.

• The use of prophylactic antibiotics in patients with hemothorax has been shown to reduce the incidence of infectious complications 2.
• A study comparing the use of ciprofloxacin and ceftazidime in the treatment of serious infections found that both antibiotics were effective, but ciprofloxacin had a lower rate of superinfections 3.
• The management of hemothorax also involves the use of chest tubes, and the optimal positioning of these tubes is crucial to prevent retained hemothorax 4, 5.
• A study on the optimal initial positioning of chest tubes found that the use of a steerable chest tube with an extendable infusion cannula can improve drainage and reduce the need for secondary interventions 4.
• Another study found that the location of the chest tube does not influence the need for secondary interventions, as long as the tube resides in the pleural space 5.

Antibiotic Treatment

• The choice of antibiotic depends on the severity of the infection and the suspected causative organisms.
• Ciprofloxacin and ceftazidime are both effective options for the treatment of serious infections, including those caused by gram-negative aerobes 3.
• The use of prophylactic antibiotics in patients with hemothorax can reduce the incidence of infectious complications, and cefazolin is a commonly used option 2.

Chest Tube Management

• The optimal positioning of chest tubes is crucial to prevent retained hemothorax and reduce the need for secondary interventions.
• A steerable chest tube with an extendable infusion cannula can improve drainage and reduce the need for secondary interventions 4.
• The location of the chest tube does not influence the need for secondary interventions, as long as the tube resides in the pleural space 5.