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Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): a prospective randomized clinical trial
L Gossner1, J Keymling, E G Hahn
1Department of Medicine II, Klinikum der Landeshauptstadt Wiesbaden, Germany.
Insights
Antibiotic prophylaxis significantly reduces peristomal wound infections after percutaneous endoscopic gastrostomy (PEG). This study recommends routine antibiotic use to lower infection risk in PEG procedures.
Area of Science:
- Gastroenterology
- Surgical Infections
- Medical Device Complications
Background:
- Peristomal wound infection is a common complication of percutaneous endoscopic gastrostomy (PEG), affecting up to 30% of patients.
- The effectiveness of antibiotic prophylaxis in preventing PEG-related peristomal infections remains a subject of debate in existing literature.
Purpose of the Study:
- To prospectively evaluate the efficacy of antibiotic prophylaxis in reducing the incidence of peristomal wound infections following PEG insertion.
- To compare different antibiotic regimens against a no-prophylaxis control group.
Main Methods:
- A prospective, randomized trial involving 347 patients undergoing PEG insertion using the "pull" technique.
- Patients were randomized into three groups: cefotaxime prophylaxis, piperacillin/tazobactam prophylaxis, or no antibiotic prophylaxis.
- Peristomal wound infections were assessed using a standardized wound score over one week, classified by severity (degree I-IV).
Main Results:
- Antibiotic prophylaxis groups demonstrated significantly lower mean daily wound scores compared to the no-prophylaxis group (P < 0.01).
- The incidence of severe peristomal infections (degree III) was significantly higher in the control group (8 patients) versus antibiotic groups (0 and 1 patient, respectively; P < 0.001 and P < 0.012).
- Overall, severe complications were rare (1.6%), with five instances noted, including three cases of peritonitis in the no-prophylaxis group.
Conclusions:
- Antibiotic prophylaxis significantly lowers the risk of peristomal wound infections associated with PEG procedures.
- Severe infections requiring intervention are infrequent after PEG insertion.
- Routine antibiotic prophylaxis is recommended for all percutaneous endoscopic gastrostomy procedures.
Background And Study Aims:
The most frequent complication reported for percutaneous endoscopic gastrostomy (PEG) is peristomal wound infection which occurs in as many as 30 % of patients. In the studies published so far, the question of whether antibiotic prophylaxis reduces the incidence of peristomal wound infection has remained controversial. We therefore conducted a prospective, randomized trial to determine whether antibiotic prophylaxis can reduce the incidence of peristomal wound infection associated with PEG.
Patients And Methods:
During a 2-year-period a total of 347 patients (251 men, 96 women; mean age 60.2+/-5) were included in our study. In all cases, a 9-French gauge Freka gastrostomy tube was inserted using the "pull" technique. The patients were randomly assigned to three different treatment groups (group 1, antibiotic prophylaxis with 2 g cefotaxime; group 2, antibiotic prophylaxis with 4g piperacillin plus 0.5g tazobactam; group 3, no antibiotic prophylaxis). For a period of one week after gastrostomy, the peristomal area was evaluated using a wound score. According to the score, peristomal infections were classified as being of degree I-IV. Infections of up to degree III were regarded as minor, while an infection of degree IV was defined as a severe complication.
Results:
PEG tubes were successfully placed in 336/347 patients (97 %). Of the 336 patients, 29 were excluded because of incomplete follow up (dropout rate 9%). Cases included were: in group 1, n = 101; in group 2, n = 100, and in group 3, n = 106. There was no mortality related to PEG insertion. There were five instances of severe complications (1.6%). Patients who received antibiotic prophylaxis had mean daily combined wound scores that were significantly lower than those of patients without antibiotic prophylaxis (P < 0.01). The control group (no antibiotic prophylaxis) exhibited significantly more peristomal wound infections of degree III (n = 8) than antibiotic prophylaxis group 1 (n = 0, P < 0.001) or antibiotic prophylaxis group 2 (n = 1, P < 0.012). Three patients in group 3 (no antibiotic prophylaxis) and one patient in group 2 developed peritonitis.
Conclusions:
Severe wound infections requiring medical or endoscopic intervention are very rare events after PEG insertion. Antibiotic prophylaxis significantly reduces the risk of peristomal wound infection associated with PEG insertion. Antibiotic prophylaxis, therefore, is to be recommended as a general measure in percutaneous endoscopic gastrostomy.