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The following is a summary of “Proper duration of antibiotics after video-assisted thoracoscopic surgery for the treatment of thoracic empyema,” published in the November 2024 issue of Infectious Disease by Ashkar et al. 

Video-assisted thoracoscopic surgery (VATS) is often required for thoracic empyema when chest tube drainage is inadequate, but the optimal duration of post-VATS antibiotic therapy remains unclear.  

Researchers conducted a retrospective study to assess the efficacy of short-duration antibiotic therapy compared to longer durations following VATS for thoracic empyema.  

They identified patients with thoracic empyema who underwent VATS by querying the hospital billing database. The bacterial causes of empyema were categorized into 8 groups, while the antibiotic duration following VATS was classified into 2 categories: antibiotics <14 days and antibiotics >14 days. The primary outcome measured was the recurrence rate of empyema and the statistical comparisons were made between the antibiotic duration groups, both overall and stratified by the bacterial cause categories.  

The results showed that 137 patients were included, with culture-negative empyema being the most common cause (37.2%), followed by alpha-hemolytic Streptococcus spp. (26.3%). There was no significant difference in empyema recurrence rates (P= 0.5168) between short (median 11.6 days) and long (median 29.1 days) antibiotic durations post-VATS. Recurrence rates also did not differ when stratified by bacterial cause.  

Investigators concluded that antibiotic durations of less than 14 days post-VATS were as effective as longer durations. However, a prospective clinical trial is needed to establish the optimal duration and minimize complications from prolonged therapy. 

Source: tandfonline.com/doi/full/10.1080/23744235.2024.2425705