What is the management of an infected Percutaneous Endoscopic Gastrostomy (PEG) tube?

From the Guidelines

Management of an infected Percutaneous Endoscopic Gastrostomy (PEG) tube requires prompt intervention with both local wound care and possibly systemic antibiotics, with consideration for tube removal if infection persists despite treatment, as recommended by the most recent guidelines 1. When managing an infected PEG tube, it is essential to consider the severity of the infection and the patient's overall health status.

• For mild infections, local wound care with topical antimicrobial agents and ensuring the tube is properly secured can be sufficient.
• For moderate to severe infections, systemic antibiotics may be necessary, with consideration for hospitalization if there are signs of sepsis or severe cellulitis.
• The external bumper should be positioned to allow for free movement of the tube and to prevent pressure-related lesions.
• Regular dressing changes and inspection of the wound site are crucial to prevent infection and promote healing.
• If infection persists despite appropriate treatment, consideration should be given to replacing the tube, as biofilm formation on the tube material can maintain the infectious process 1. It is also important to note that certain patient populations, such as those with diabetes, obesity, or immunosuppression, may be at increased risk for infection and require closer monitoring and more aggressive treatment.
• Prevention of infection is key, and this can be achieved through proper wound care, regular dressing changes, and ensuring the tube is properly secured 1.
• The use of antimicrobial ointments or dressings with sustained release of antimicrobial agents, such as silver or iodine, can also be beneficial in preventing infection 1. Overall, the management of an infected PEG tube requires a comprehensive approach that takes into account the severity of the infection, the patient's overall health status, and the need for prompt and effective treatment to prevent complications and promote healing.

From the Research

Management of Infected PEG Tube

• The management of an infected Percutaneous Endoscopic Gastrostomy (PEG) tube involves preventing and treating complications associated with the tube, including wound infection, occlusion, and inadvertent removal 2.
• Antibiotic prophylaxis is recommended to reduce the risk of peristomal wound infection associated with PEG insertion 3, 4.
• The choice of antibiotic prophylaxis should be tailored to local organisms to reduce the incidence and severity of peri-stomal PEG infections 5.
• Strategies for preventing complications include regular follow-up, pre-discharge instructions, and programmed tube changes 2.
• Management of site infection includes local antibiotic therapy, skin care, and intravenous antibiotic therapy 2.

Prevention of PEG Tube Infection

• Antibiotic prophylaxis with cefotaxime or piperacillin plus tazobactam can reduce the incidence of peristomal wound infection 3.
• A single dose of oral sulfamethoxazole and trimethoprim deposited in the PEG catheter immediately after insertion can also prevent wound infection 4.
• Tailoring antibiotic prophylaxis to local organisms can reduce the incidence and severity of peri-stomal PEG infections 5.

Treatment of PEG Tube Infection

• Local antibiotic therapy and skin care can be used to manage site infection 2.
• Intravenous antibiotic therapy may be necessary for more severe infections 2.
• Replacement of the PEG tube may be necessary in cases of occlusion or inadvertent removal 2.