Systemic Prophylactic Antibiotics for the Modified Introducer Method for Percutaneous Endoscopic Gastrostomy: A...

Area of Science:

• Gastroenterology
• Infectious Disease Prevention
• Surgical Procedures

Background:

• Percutaneous endoscopic gastrostomy (PEG) is a common method for long-term enteral nutrition.
• Systemic prophylactic antibiotics for PEG are known to reduce peristomal infections.
• Recent procedural and instrument advancements may have reduced infection risks.

Purpose of the Study:

• To evaluate the efficacy of systemic antibiotic prophylaxis in a modified introducer method of PEG.
• To assess the impact of antibiotic prophylaxis on wound and peristomal infections after PEG placement.

Main Methods:

• Prospective, randomized, double-blind trial involving 91 patients undergoing PEG.
• Patients were randomized to receive prophylactic ampicillin (46 patients) or a placebo (45 patients).
• A modified introducer method using a Seldinger PEG kit was employed, with wound infection within 3 days as the primary outcome.

Main Results:

• No wound infections occurred within 3 days in the antibiotic prophylaxis group, versus one in the placebo group (P=0.4945).
• No significant differences were observed between groups for peristomal infection within 7 days, overall infection rates, or inflammatory markers.
• The study preliminarily suggested noninferiority of placebo to antibiotics for early wound infection.

Conclusions:

• Antibiotic prophylaxis did not demonstrate a significant benefit for preventing early wound infections in this modified PEG procedure.
• Noninferiority was suggested for early wound infection but not for peristomal infection within 7 days.
• Larger studies with stricter noninferiority criteria are recommended for further investigation.