Related Experiment Video
Updated: Aug 9, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Methicillin-resistant Staphylococcus aureus infection of percutaneous endoscopic gastrostomy sites
1Division of Medicine, St James's University Hospital, Leeds, UK. medmah@stjames.leeds.ac.uk
Background:
Antibiotic prophylaxis for percutaneous endoscopic gastrostomy insertion remains controversial. The bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion has been poorly studied, leading to uncertainty regarding the optimum choice of antibiotic for prophylaxis.
Aim:
To investigate the bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion and to determine the contribution of methicillin-resistant Staphylococcus aureus.
Methods:
Nasal and pharyngeal swabs were taken from a consecutive series of patients prior to percutaneous endoscopic gastrostomy insertion over a 6-month period. Bacterial colonization and infection at the peristomal site were prospectively evaluated at days 2/3 and 7 post-insertion.
Results:
Thirty-one patients underwent percutaneous endoscopic gastrostomy insertion (mean age, 68 years; cerebrovascular disease, 52%). Naso-pharyngeal colonization by methicillin-resistant Staphylococcus aureus (35%) invariably led to peristomal colonization following percutaneous endoscopic gastrostomy insertion. Peristomal infection occurred in eight (26%) cases (seven (88%) methicillin-resistant Staphylococcus aureus- positive). Peristomal infection was significantly more likely to occur in patients with naso-pharyngeal methicillin-resistant Staphylococcus aureus colonization (odds ratio, 10.8; 95% confidence interval, 1.6-70.9).
Conclusions:
Naso-pharyngeal methicillin-resistant Staphylococcus aureus colonization invariably predicts peristomal methicillin-resistant Staphylococcus aureus colonization following percutaneous endoscopic gastrostomy insertion, and is associated with an increased peristomal infection rate. Currently recommended antibiotic prophylaxis regimens may be inappropriate in institutions with significant methicillin-resistant Staphylococcus aureus colonization rates.
Insights
Naso-pharyngeal methicillin-resistant Staphylococcus aureus colonization predicts peristomal infection after gastrostomy. Current antibiotic prophylaxis may be ineffective against this pathogen.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Microbiology
Background:
- Antibiotic prophylaxis for percutaneous endoscopic gastrostomy (PEG) insertion is debated.
- The microbiology of PEG site infections is understudied, impacting prophylaxis choices.
Purpose of the Study:
- Investigate peristomal infection bacteriology after PEG insertion.
- Determine the role of methicillin-resistant Staphylococcus aureus (MRSA) in these infections.
Main Methods:
- Collected nasal and pharyngeal swabs from patients before PEG insertion.
- Prospectively monitored peristomal colonization and infection at 2-3 and 7 days post-insertion.
Main Results:
- 31 patients underwent PEG insertion; 35% had MRSA naso-pharyngeal colonization.
- MRSA colonization invariably led to peristomal colonization.
- Peristomal infection occurred in 26% of cases, with 88% being MRSA-positive.
- Naso-pharyngeal MRSA colonization significantly increased peristomal infection risk (OR 10.8).
Conclusions:
- Naso-pharyngeal MRSA colonization predicts peristomal MRSA colonization and infection post-PEG.
- Standard antibiotic prophylaxis may be inadequate in areas with high MRSA rates.
Related Concept Videos
01:29Staphylococcal Skin Infections
01:25Mechanism of Antibiotic Resistance in MRSA
01:25Clinical Significance of Antibiotic Resistance