Microbiology of gastrostomy site wound infections in children

Specimens of pus were obtained from gastrostomy site wound infections in 22 children. Polymicrobial flora was found in 21 of the 22 wounds. Aerobic or facultative bacteria only were isolated in eight (36%) instances and mixed aerobic-anaerobic flora were isolated from the other 14 (64%) wounds. A total of 102 bacterial isolates (57 aerobic and 45 anaerobic) and seven cultures of candida were obtained. The most frequent isolates were Escherichia coli (16 isolates). Peptostreptococcus spp. (14), Enterococcus spp. (14), Bacteroides spp. (12) and Staphylococcus aureus (6). Twenty-eight strains producing beta-lactamase were isolated from 16 (73%) patients. The presence of polymicrobial aerobic-anaerobic infection, and the isolation of E. coli and Bacteroides spp. were more frequent in wounds with gastric leakage than in wounds without gastric leakage (p < 0.05). Bacteria similar to those isolated from the wound were also isolated from blood cultures from three patients-two isolates of E. coli and one each of B. fragilis and S. aureus. All patients received local therapy and 11 were treated with systemic antimicrobial agents. The polymicrobial aerobic-anaerobic flora of gastrostomy site wound infections, especially in association with gastric leakage, and the presence of beta-lactamase producers in most of these infections may have important implications for their management.