Does systemic antimicrobial prophylaxis prevent peristomal infection after percutaneous endoscopic gastrostomy?

Abstract: Objective: The current study was conducted to review and compare PEG and Gastrostomy in terms of early complications in head and neck cancer patients. Materials and Methods: This was prospective comparative study recruited total 60 patients as per the inclusion criteria, 30 in each group. Patients were assigned to the groups based on the surgeon’s choice. Ethical clearance was taken from ethical review board. Informed consent was taken from patients before enrolling them into the study. Non-probability consecutive sampling technique was used to enroll study participants. Data was collected on pre-designed performa and analyzed using SPSS version 16. Setting: Section of Otolaryngology, Department of Surgery, Aga Khan University Hospital Karachi. Results: The two groups did not differ on basis of age, gender and tumor site. The outcomes variables including pain and bleeding from post-operative day1 to day 5 were significantly lower in patients who underwent PEG placement as compared to patients whom we performed OPEN gastrostomy. None the patient had peristomal infection in PEG group throughout the study. However, difference between the groups was statistically significant from post-operative day 3 to day 5. Conclusion: In our study, PEG was associated with lesser complications than open gastrostomy. Recently clinicians are using newer modalities like radiological and laparoscopic gastrostomy at various centres in Pakistan as the first option for placing feeding gastrostomy. Therefore, future studies are warranted to compare their efficacy and post-operative complications PEG. Keywords: Head and neck cancer, Open gastrostomy, Percutaneous endoscopic gastrostomy, Complications, Pain, Peristomal infection, Bleeding

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Faculty Opinions recommendation of Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718176868.793487370 ◽

2013 ◽

Author(s):

Ian Beales

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Antimicrobial Prophylaxis ◽

Endoscopic Gastrostomy

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Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032012000400005 ◽

2012 ◽

Vol 49 (4) ◽

pp. 255-258 ◽

Cited By ~ 8

Author(s):

Helena Duarte ◽

Carla Santos ◽

Manuel Luís Capelas ◽

Jorge Fonseca

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Antibiotic Prophylaxis ◽

Percutaneous Endoscopic Gastrostomy ◽

Infection Rates ◽

Healthcare Associated Infection ◽

Methicillin Resistant ◽

Endoscopic Gastrostomy ◽

Peristomal Infection ◽

Healthcare Associated

CONTEXT: Healthcare-associated infection represents the most frequent adverse event during care delivery. Medical advances like percutaneous endoscopic gastrostomy have brought improvement on quality of life to patients but an increased risk of healthcare-associated infection. Predictive risk factors for peristomal wound infection are largely unknown but evidence suggests that antibiotic prophylaxis and preventive strategies related to infection control may reduce infection rates. OBJECTIVES: The primary aim was to evaluate the global prevalence rate of peristomal infection. Secondary objectives were to characterise the positive culture results, to evaluate the prophylactic antibiotic protocol and to identify potential risk factors for peristomal infection. METHODS: Retrospective study of 297 patients with percutaneous endoscopic gastrostomy performed at a general hospital between January 2004 and September 2010. Patients received prophylactic cefazolin before the endoscopic gastrostomy procedure. Medical records were reviewed for demographic data, underling disease conditions to percutaneous endoscopic gastrostomy and patient potential intrinsic risk factors. Statistical analysis was made with the statistical program SPSS 17.0. RESULTS: A total of 297 percutaneous endoscopic gastrostomy tubes were inserted. Wound infection occurred in 36 patients (12.1%). Staphylococcus aureus methicillin resistant was the most frequently isolated microorganism (33.3%) followed by Pseudomonas aeruginosa (30.6%). The incidence rate had been rising each year and differ from 4.65% in 2004/2007 to 17.9% in 2008/2010. This finding was consistent with the increasing of prevalence global infection rates of the hospital. Most of the infections (55.6%) were detected in the first 10 days post procedure. There was no significant difference in age, body mass index values, mean survival time and duration of percutaneous endoscopic gastrostomy feeding between patients with and without periostomal infection. Institutional factors, namely global prevalence infection rates and the endemic character of Staphylococcus aureus methicillin resistant, play an important role in peristomal infection rates. Traditional antibiotic prophylaxis with cefazolin is not adequate due to the prevalence of resistant organisms. CONCLUSIONS: Peristomal infection is a frequent problem with clinical impact in percutaneous endoscopic gastrostomy patients and should be considered a healthcare associated infection. The antimicrobial prophylaxis regimens using cephalosporins are not adequate and need to be reviewed due to the high prevalence of Staphylococcus aureus methicillin resistant and other resistant organisms in hospitals and nursing homes.

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