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

Abstract

-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.

The role of surgical gastrostomy in the age of endoscopic gastrostomy: a 13 years and 543 patients retrospective study

“…This may also reflect the complexity and precarious state of the patients submitted to major surgical procedures that included OSG. The peristomal infection rate for OSG was 16.7%, similar to the previous infection rate reported for our PEG-patients stoma infection (15). No peristomal infections were recorded in any of the eight patients undergoing LG.…”

Incidence of Percutaneous Endoscopic Gastrostomy Site Wound Infection among Frail Elderly Patients Admitted in a Tertiary Medical Center

“…In our study, the microorganisms cultured from PEG wounds were: MRSA, Pseudomonas aeruginosa, Klebsiella pneumo niae, Enterococcus faecalis and Acinetobacter baumannii which reflects hospital acquired infection. The most common organism isolated from culture is Klebsiella pneumonia which is different from other studies done in other countries wherein their most common are: Pseudomonas aeruginosa and MRSA [10,13]. The high prevalence of multi-drug resistant organism and the high number of polymicrobial infection was one of the most important findings of our study.…”

“…The incidence rate of PEG site infections across all age group ranges from 12 to 32% [9][10][11][12]. In our study, the incidence of PEG site infection in frail elderly person falls within the range which is 29.4%.…”

Percutaneous endoscopic gastrostomy (PEG) site infections: a clinical and microbiological study from university teaching hospital, India

“…PEG stoma infection can compromise patients’ quality of life and impact on morbidity. Meticillin resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa , and Gram negative enteric bacteria have been implicated as a cause of these infection (Chaudhary et al, 2002; Gopal Rao et al, 2004; Maine et al, 2006; Duarte et al, 2012a,b). Single dose broad-spectrum antibiotic prophylaxis such as cephalosporins reduces the incidence with absolute risk reduction of 14%–17% (Allison et al, 2009).…”