Antimicrobial Treatment for PEG Site Infections
For PEG site infections, an antimicrobial dressing with silver, iodine, or polyhexamethylene biguanide is recommended as first-line topical treatment, with silver sulfadiazine cream being an appropriate option for bacterial infections. 1
Diagnosis of PEG Site Infection
Before selecting an antimicrobial treatment, confirm infection by looking for:
- Erythema around the PEG site
- Purulent or malodorous discharge
- Loss of skin integrity
- Pain at the site
- Fever 1
It's important to swab the area for both bacterial and fungal cultures to guide targeted treatment 2.
Antimicrobial Treatment Options
For Bacterial Infections:
- Silver sulfadiazine cream 1% - FDA-approved for prevention and treatment of wound sepsis 3
- Antimicrobial dressings containing:
For Fungal Infections:
- Nystatin cream - Appropriate for confirmed or suspected fungal infections 1
Treatment Algorithm
- Clean the site daily with antimicrobial cleanser
- Apply appropriate antimicrobial agent based on suspected pathogen:
- For suspected bacterial infection: Apply silver sulfadiazine cream or antimicrobial dressing
- For suspected fungal infection: Apply nystatin cream
- Monitor response to topical treatment
- If infection worsens or doesn't improve with topical treatment:
- Add systemic antibiotics (based on culture results if available)
- Consider tube removal if infection persists despite combined treatment 2
Common Pathogens to Consider
PEG site infections are commonly caused by:
Recent studies show MRSA is emerging as a major pathogen in PEG site infections 4, and Pseudomonas aeruginosa is also frequently isolated 5, 6.
Important Considerations
- Avoid overtightening the external bolster, which can increase infection risk 1
- Avoid topical antibiotics as they may promote resistance 1
- Don't neglect fungal infections - Candida infections can be severe and even fatal in immunocompromised patients 7
- High-risk patients (diabetes, obesity, immunosuppression) require closer monitoring 2, 1
- Consider tube removal in refractory cases that don't respond to antimicrobial treatment 2
Prevention Strategies
- Clean the site daily during the first week after insertion using aseptic technique
- After initial healing (5-7 days), clean with soap and water
- Ensure proper positioning of the external fixation plate
- Allow free movement of at least 5mm to prevent pressure necrosis 1
Proper site care and appropriate antimicrobial treatment are essential for managing PEG site infections and preventing complications that could impact morbidity and mortality.