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PEG site infections: the emergence of methicillin resistant Staphylococcus aureus as a major pathogen
Kamran A Chaudhary1, Owen J Smith, Paul G Cuddy
1University of Missouri-Kansas City School of Medicine, Truman Medical Center, USA.
Objective:
We reviewed the records of 126 patients who underwent PEG insertion during a 36-month period to determine the etiology of an observed increase in PEG-related infections.
Methods:
Charts were reviewed to determine predictive factors of infection, the occurrence of infection, and culture results of infected sites. Insertion was performed in all cases using a standard sterile, pull-through technique. Infections were defined as having at least two of the following conditions: peristomal erythema, induration, and purulent discharge.
Results:
PEG infections occurred in 22 patients. During the first 12-month interval, 0 of 25 patients (0%) had PEG-related infections; during the second 12-month interval, four of 37 patients (10.8%); and during the third 12-month interval, 18 of 64 patients (28.1%) (p < 0.05). Cultures from 14 of 22 peristomal infections grew methicillin resistant Staphylococcus aureus (nine), pseudomonads (three), and other organisms (two). One hundred twenty-four of 126 patients received prophylactic antibiotics or were receiving concomitant antibiotics. Of the infected patients, 21 of 22 (95.5%) received prophylaxis, and 11 of 22 (50%) were receiving concomitant antibiotics before PEG. In the noninfected group, 78 of 104 (75%) received prophylaxis, and 47 of 104 (45.2%) received concomitant antibiotics.
Conclusions:
Methicillin resistant Staphylococcus aureus is emerging as a major pathogen in PEG site infections. Further prospective studies are needed to establish whether current prophylactic antibiotic recommendations are adequate.
Insights
Percutaneous endoscopic gastrostomy (PEG) site infections increased significantly over 36 months, with methicillin-resistant Staphylococcus aureus identified as a key pathogen. Further research is needed on antibiotic prophylaxis efficacy for PEG procedures.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Site Infections
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common procedure for enteral feeding.
- An increase in PEG-related infections has been observed, necessitating an investigation into its causes.
Purpose of the Study:
- To determine the etiology of the rising incidence of PEG-related infections.
- To identify predictive factors and common pathogens associated with PEG site infections.
Main Methods:
- A retrospective review of 126 patients who underwent PEG insertion over 36 months.
- Infections were defined by specific clinical criteria (peristomal erythema, induration, purulent discharge).
- Culture results from infected sites were analyzed.
Main Results:
- PEG-related infections rose from 0% in the first year to 28.1% in the third year (p < 0.05).
- Methicillin-resistant Staphylococcus aureus (MRSA) was the most common pathogen (9/14 cultures).
- Most infected patients received prophylactic or concomitant antibiotics, suggesting current regimens may be inadequate.
Conclusions:
- MRSA is an emerging pathogen in PEG site infections.
- Current prophylactic antibiotic strategies for PEG insertion may require re-evaluation.
- Prospective studies are essential to optimize antibiotic prophylaxis for PEG procedures.