Antibiotic prophylaxis tailored to local organisms reduces percutaneous gastrostomy site infection.

Mahadeva, S.; Sam, I.-C.; Khoo, B.-L.; Khoo, P.-S.; Goh, K.-L.

Background: Current recommendations for the choice of antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy (PEG) insertion may not be suitable in all situations. Aims: We sought to review the microbiology of PEG-wound infections at our institution locally and observe PEG infection rates following a change in antibiotic policy. Methods: A retrospective clinical and microbiological review of all PEG-wound infections resulted in a change in the choice of antibiotic. A further review was conducted 2 years later to examine the effect of this change. Results: PEG-wound infection was detected in 33/103 (32.0%) patients between January 2002 and May 2004 with either second generation cephalosporins or co-amoxiclav antibiotic prophylaxis, with the commonest organisms being Pseudomonas aeruginosa (16.7%), Klebsiella species (9.9%) and methicillin-resistant Staphylococcus aureus (5.3%). Microbiological data revealed high levels of resistance to cefuroxime (60.7%) and co-amoxiclav (51%). A change of prophylaxis to cefoperazone (during the period June 2004–May 2006) resulted in a reduction of PEG-wound infections to 17/90 (18.9%) patients that required PEG tube insertion (p = 0.04). Together with a reduction in P. aeruginosa infections (18.4–10%, p = 0.10), a lower incidence of pyrexia (10.7% vs. 3.3%, p = 0.05), lower antibiotic administration (20.4% vs. 11.1%, p = 0.08) and lower rate of PEG removal (23.2% vs. 10.2%, p = 0.018) were noted following prophylaxis change. Conclusions: Antibiotic prophylaxis for PEG should be tailored to local organisms as this approach reduces the incidence and severity of peri-stomal PEG infections.

International Journal of Clinical Practice, 2009, Vol 63, Issue 5, p760

1368-5031

Academic Journal

10.1111/j.1742-1241.2008.01881.x