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Prophylactic Antibiotics to Reduce Morbidity and Mortality in Newborn Infants with Intercostal Catheters (Review)

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Prophylactic Antibiotics to Reduce Morbidity and Mortality in Newborn Infants with Intercostal Catheters (Review) Cochrane Database of Systematic Reviews Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters (Review) Stewart A, Inglis GDT, Jardine LA, Koorts P, Davies MW Stewart A, Inglis GDT, Jardine LA, Koorts P, Davies MW. Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008173. DOI: 10.1002/14651858.CD008173.pub2. www.cochranelibrary.com Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters (Review) Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 5 DISCUSSION ..................................... 6 AUTHORS’CONCLUSIONS . 6 REFERENCES ..................................... 6 CHARACTERISTICSOFSTUDIES . 8 DATAANDANALYSES. 10 HISTORY....................................... 10 CONTRIBUTIONSOFAUTHORS . 10 DECLARATIONSOFINTEREST . 10 SOURCESOFSUPPORT . 10 INDEXTERMS .................................... 10 Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters (Review) i Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. [Intervention Review] Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters Alice Stewart1, Garry DT Inglis2, Luke A Jardine3, Pieter Koorts4, Mark W Davies2 1Monash Newborn, Monash Medical Centre, Clayton, Australia. 2Grantley Stable Neonatal Unit, Royal Brisbane and Women’s Hospital, Department of Paediatrics & Child Health, The University of Queensland, Brisbane, Australia. 3Department of Neonatology, Mater Mother’s Hospital, Mater Medical Research Institute, The University of Queensland, South Brisbane, Australia. 4Grantley Stable Neonatal Unit, Royal Brisbane and Women’s Hospital, Brisbane, Australia Contact address: Alice Stewart, Monash Newborn, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3158, Australia. [email protected]. Editorial group: Cochrane Neonatal Group. Publication status and date: New, published in Issue 4, 2012. Review content assessed as up-to-date: 16 June 2011. Citation: Stewart A, Inglis GDT, Jardine LA, Koorts P, Davies MW. Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008173. DOI: 10.1002/14651858.CD008173.pub2. Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. ABSTRACT Background Intercostal catheters are commonly used for the drainage of intrathoracic collections in newborn infants, including pneumothorax and pleural effusions. Placement of an intercostal drain is a potential risk factor for nosocomial infection due to breach of the cutaneous barrier. Therefore, neonates who require intercostal drainage, especially those in high risk groups for nosocomial infection, may benefit from antibiotic prophylaxis. However, injudicious antibiotic use carries the risk of promoting the emergence of resistant strains of micro-organisms or of altering the pattern of pathogens causing infection. Objectives To determine the effect of prophylactic antibiotics compared to selective use of antibiotics on mortality and morbidity (especially septicaemia) in neonates undergoing placement of an intercostal catheter. Search methods The standard search strategy of the Cochrane Neonatal Review Group was used to search the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 5), MEDLINE (1948 to June 2011) and CINAHL (1982 to June 2011). Selection criteria Randomised controlled trials or some types of non-randomised (that is, quasi-randomised) controlled trials of adequate quality in which either individual newborn infants or clusters of infants were randomised to receive prophylactic antibiotics versus placebo or no treatment. Data collection and analysis We used the standard methods of the Cochrane Neonatal Review Group. Main results We did not find any randomised controlled trials that met the eligibility criteria. Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters (Review) 1 Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Authors’ conclusions There are no data from randomised trials to either support or refute the use of antibiotic prophylaxis for intercostal catheter insertion in neonates. Any randomised controlled trials of antibiotic prophylaxis would need to account for the fact that neonates who require insertion of an intercostal catheter may already be receiving antibiotics for other indications. PLAIN LANGUAGE SUMMARY Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters There is no evidence to support or refute the use of preventive antibiotics in newborn babies with drainage tubes placed in the chest. Sick newborn babies occasionally need the insertion of a tube that is placed through the skin and into the lung space to drain air or fluid from around their lungs. Because this process involves breaching the skin barrier, there is a potential risk of infection. The group of babies most likely to need this procedure are also those that are most at risk of developing an infection during their stay in hospital. Preventive antibiotics are commonly used when there is a risk of infection, but they may have unwanted effects. The review authors found no evidence to support or refute the use of routine preventive antibiotics when intercostal catheters are inserted in newborn babies. BACKGROUND longed duration and increased severity of respiratory illness (in- cluding chronic lung disease and the need for respiratory sup- port) (Greenough 2005), increased length of hospital stay (Mireya Description of the condition 2007) and impaired neurodevelopmental outcomes (Stoll 2004). Documented complications of intercostal catheters in both pae- Intercostal catheters are commonly used for the drainage of in- diatric and adult populations include localised cellulitis (Margau trathoracic collections in newborn infants, including pneumoth- 2006) and empyema (Bailey 2000). The incidence of empyema orax and pleural effusions. Placement of intercostal catheters is following intercostal drainage has been reported at about 2% common in critically ill neonates, especially in infants with birth- (Millikan 1980; Chan 1997; Bailey 2000). Potential factors to be weight less than 1500 g (very low birth weight infants, VLBW). implicated in infection of the drain site and pleural space include The Vermont Oxford Network Database reported an incidence failure of the aseptic technique, advancement of a pre-existing of pneumothorax in VLBW infants ranging from 5.1% to 8.6% drain into the pleural space and duration of intercostal drainage (1991 to 1996) (Horbar 2002). (Tang 2002). Factors that might affect the risk of infection, in- As with any procedure involving breach of the cutaneous barrier, cluding geographic location of insertion (operating theatre, inten- intercostal drainage is a potential risk factor for nosocomial infec- sive care unit, retrieval site), patient acuity at the time of catheter tion. Additionally, by virtue of their underlying illness, patients re- placement, and the skill level of the operator, have been incom- quiring intercostal catheters may have impaired local and systemic pletely studied (Baumann 2003). defence mechanisms. Premature and low birth weight infants are There are currently no published recommendations on the use of particularly at risk. Retrospective data from the National Institute prophylactic antibiotics for intercostal catheters for non-traumatic of Child Health and Development (NICHD) Neonatal Research indications. In adult chest trauma patients requiring intercostal Network, USA, demonstrated an incidence of pneumothorax from drainage, several studies have found evidence of benefit from sin- 1990 to 2002 of 13% in infants weighing 501 to 750 g and 6% gle-dose antimicrobial prophylaxis (Grover 1977; LeBlanc 1985; in infants weighing 751 to 1000 g (Fanaroff 2007). In these same Demetriades 1991) and published evidence-based guidelines for populations, the incidence of late-onset septicaemia was 44% and chest trauma make a level III recommendation (based on class I 30% respectively. Hence, the group of premature neonates most and II data) for up to 24 hours of cover with a first generation likely to require an intercostal catheter are also those most at risk cephalosporin (Luchette 2000). However, for non-traumatic indi- of morbidity and mortality as a result of nosocomial infection. cations across all age groups there remains variability in practice, Infection secondary to the use of intercostal catheters may cause including the timing, target population and choice of antibiotics. significant morbidity and mortality. Morbidity may include pro- Prophylactic antibiotics to reduce morbidity and mortality in newborn infants with intercostal catheters (Review) 2 Copyright © 2012 The Cochrane Collaboration. Published by John Wiley
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