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Nasopharyngeal decolonization of methicillin-resistant Staphylococcus aureus can reduce PEG peristomal wound

Akira Horiuchi1, Yoshiko Nakayama, Masashi Kajiyama

  • 1Departments of Gastroenterology and Pediatrics, Showa Inan General Hospital, Komagane, Japan.

The American Journal of Gastroenterology
|February 4, 2006
PubMed
Abstract

Insights

Nasopharyngeal decolonization of methicillin-resistant Staphylococcus aureus (MRSA) significantly reduced peristomal infections after percutaneous endoscopic gastrostomy (PEG) placement. Eradicating MRSA from the nose prevented wound infections in patients undergoing PEG procedures.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Surgical Site Infections

Background:

  • Peristomal wound infection is a complication following percutaneous endoscopic gastrostomy (PEG) placement.
  • Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in healthcare-associated infections.
  • The role of nasopharyngeal MRSA carriage in the development of peristomal infections requires further investigation.

Purpose of the Study:

  • To determine if nasopharyngeal decolonization of MRSA can reduce peristomal wound infections after PEG placement.
  • To evaluate the efficacy of a combination therapy for MRSA eradication.

Main Methods:

  • A randomized trial involving 72 patients undergoing PEG insertion.
  • Patients were categorized into three groups based on nasopharyngeal MRSA status: negative, positive (not eradicated), and positive (eradicated).
  • Eradication therapy included intranasal mupirocin, arbekacin inhalation, and oral sulfamethoxazole/trimethoprim.

Main Results:

  • The peristomal infection rate was 0% in MRSA-negative patients, 100% in MRSA-positive (not eradicated) patients, and 8% in the MRSA-eradicated group.
  • The combination therapy successfully eradicated MRSA from the nasopharynx in all treated patients.
  • MRSA was isolated from purulent discharge in most infected patients.

Conclusions:

  • Nasopharyngeal decolonization of MRSA effectively reduces peristomal infections following PEG insertion.
  • MRSA is a primary cause of peristomal infections, even with prophylactic and concomitant antibiotic use.
  • Targeting nasopharyngeal MRSA carriage is a viable strategy to prevent surgical site infections.

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