Percutaneous endoscopic gastrostomy site infections—Incidence and risk factors

• Published in: Indian journal of gastroenterology Vol. 37; no. 2; pp. 103 - 107
• Main Authors: Vizhi, Kayal, Rao, Harshavardhan B., Venu, Rama P.
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01-03-2018
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis; Endoscopy, Gastrointestinal - adverse effects; Enteral Nutrition - methods; Female; Follow-Up Studies; Gastroenterology; Gastrostomy - adverse effects; Hepatology; Humans; Incidence; Klebsiella; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pseudomonas; Retrospective Studies; Risk Factors; Surgical Stomas - microbiology; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surgical Wound Infection - microbiology; Surgical Wound Infection - prevention & control; Gastrostomy; Nutrition; Percutaneous endoscopic gastrostomy; Complications; Enteral; Infections; Endoscopic
• ISSN: 0254-8860; 0975-0711
• DOI: 10.1007/s12664-018-0822-4

Background
Percutaneous endoscopic gastrostomy (PEG) placement is the modality of choice for long-term enteral nutrition in view of technical ease and cost-effectiveness. Peristomal infection (PI) remains the most common complication following PEG tube placement. The aim of this study was to assess the incidence and risk factors for PI and outline a microbiological profile that can aid in prophylactic and therapeutic strategies.
Methods
A retrospective study of 781 patients who underwent PEG placement (Cook PEG-Pull-S-20Fr/24Fr) from 2010 to 2015 at our tertiary care center were included. Relevant data were collected from the hospital electronic medical records. The incidence of PI was computed and potential risk factors were assessed using univariate analysis. The microbiological profile was created along with sensitivity patterns after reviewing the culture reports. Statistical analysis was performed using SPSS version 20.0.
Results
PEG tube placement was performed in 781 patients (mean age 55.9 ± 36.1; M:F = 2:75). The major indication was oropharyngeal malignancies. PI was seen in 171 patients (21.9%). Diabetes mellitus, duration of hospital stay more than 7 days, and hypoalbuminemia were found to be significant risk factors for the development of PI (
p
 < 0.05). Patients who had chemotherapy or radiotherapy before PEG placement had a higher incidence of peristomal infections (
p
0.00). Pseudomonas and Klebsiella were the most common organisms causing infection.
Conclusions
PI remains a significant complication of PEG placement. Pseudomonas and Klebsiella are the most common organisms and prophylactic antibiotic protocols should be tailored accordingly. Elective PEG before the institution of chemotherapy/radiotherapy in patients with oropharyngeal malignancies is recommended.