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Antibacterial gauzes are effective in preventing infections after percutaneous endoscopic gastrostomy placement: a
Denise Strijbos1, Erik J Schoon, Wouter Curvers
1Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands.
Insights
Antibacterial gauzes effectively prevent peristomal wound infections after percutaneous endoscopic gastrostomy (PEG) placement, achieving comparable results to traditional antibiotics. This method offers a practical, patient-friendly, and cost-effective alternative for infection control in PEG procedures.
Area of Science:
- Gastroenterology
- Infectious Disease Prevention
- Surgical Site Infection Control
Background:
- Percutaneous endoscopic gastrostomy (PEG) placement commonly results in peristomal wound infections, occurring in up to 40% of cases without antibiotic prophylaxis.
- Current guidelines recommend single-dose parenteral prophylactic antibiotics, reducing infection rates to 9-15%.
- The potential for local antibiotic treatment with antibacterial gauzes to offer a prolonged effect is unexplored.
Purpose of the Study:
- To evaluate the efficacy of antibacterial gauzes in preventing infections following PEG insertion.
- To compare the infection rates associated with antibacterial gauzes to historical data for parenteral antibiotics.
- To assess the safety and practicality of using antibacterial gauzes as a sole prophylactic measure.
Main Methods:
- Retrospective analysis of 331 patients undergoing PEG insertion between January 2009 and October 2014.
- Application of polyhexamethylene biguanide-impregnated antibacterial gauzes for 3 days post-PEG insertion.
- Exclusion of all other antibiotic administrations.
- Monitoring for wound infections, peritonitis, necrotizing fasciitis, and other complications within 2 weeks and long-term post-procedure.
Main Results:
- An overall infection rate of 9.4% was observed within 2 weeks of PEG insertion (8.2% minor, 1.2% major infections including peritonitis).
- No cases of wound infection-related mortality or bacterial resistance were reported.
- Antibacterial gauzes demonstrated a fivefold cost reduction compared to antibiotics and were found to be more practical and patient-friendly.
Conclusions:
- Antibacterial gauzes are comparable to parenteral antibiotics in preventing peristomal wound infections after PEG placement, with a 9.4% infection rate.
- The incidence of other complications was consistent with current literature.
- Local application of antibacterial gauzes presents a viable, cost-effective, and user-friendly alternative for infection prophylaxis in PEG procedures.
Objectives:
The most common complication after percutaneous endoscopic gastrostomy (PEG) placement is peristomal wound infection (up to 40% without antibiotic prophylaxis). Single-dose parenteral prophylactic antibiotics as advised by current guidelines decrease the infection rate to 9-15%. We assume a prolonged effect of local antibiotic treatment with antibacterial gauzes. This study is the first to describe the effect of antibacterial gauzes in preventing infections in PEG without the use of antibiotics.
Methods:
A retrospective data analysis was carried out of all patients with PEG insertion between January 2009 and October 2014 in the Catharina Hospital Eindhoven. Data include placement and the period of the first 2 weeks after PEG placement, and long-term follow-up. All patients received a locally applied antibacterial gauze polyhexamethylene biguanide immediately following PEG insertion for 3 days. No other antibiotics were administered. The main outcomes were wound infection, peritonitis, and necrotizing fasciitis; secondary outcomes included other complications.
Results:
A total of 331 patients with only antibacterial gauzes were analyzed. The total number of infections 2 weeks after PEG insertion was 9.4%, including 8.2% minor and 1.2% major infections (peritonitis). No wound infection-related mortality or bacterial resistance was found. Costs are five times lower than antibiotics, and gauzes are more practical and patient friendly for use.
Conclusion:
Retrospectively, antibacterial gauzes are at least comparable with literature data on parenteral antibiotics in preventing peristomal wound infection after PEG placement, with an infection rate of 9.4%. Rates of other complications found in this study were comparable with current literature data.
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