From the Guidelines
The treatment for percutaneous endoscopic gastrostomy (PEG) tube infection involves topical application of an antimicrobial agent to the entry site of the tube and the surrounding tissue, and if the site infection cannot be resolved by this treatment, combined with systemic broad-spectrum antibiotics.
Treatment Approach
- The first step in managing a PEG tube infection is to apply an antimicrobial agent topically to the entry site of the tube and the surrounding tissue 1.
- If the infection persists, systemic broad-spectrum antibiotics can be used in combination with topical treatment 1.
- It is essential to ensure that the external bolster is not too tight, causing excessive pressure between the internal and external bolster, which can promote infection 1.
- The area can be swabbed for both bacterial and fungal infection, and an antimicrobial ointment or dressing with an antimicrobial agent can be used to deliver sustained release to the gastrostomy site 1.
Important Considerations
- Patients with diabetes, obesity, poor nutritional status, and those on chronic corticosteroid therapy or other immunosuppressive therapy are at increased risk for infection 1.
- Hyper-hydrated or inflamed skin due to leakage can promote the growth of microorganisms, and prevention consists of first-line aseptic wound care after placement and early detection of signs and symptoms of infection 1.
- If the infection cannot be resolved by the above treatment, the tube should be removed 1.
- In cases of stoma tract disruption, peristomal infection that persists despite appropriate antimicrobial treatment, skin excoriation, or fungal infection, it is advisable to remove and/or replace the gastrostomy tube 1.
From the Research
Treatment for PEG Tube Infection
The treatment for percutaneous endoscopic gastrostomy (PEG) tube infection includes:
- Local antibiotic therapy 2
- Skin care 2
- Intravenous antibiotic therapy 2
- Antibiotic prophylaxis, such as cefotaxime and clindamycin, has been shown to be effective in reducing the incidence of acute complications due to PEG placement, including site infection 3, 4
Antibiotic Prophylaxis
Antibiotic prophylaxis has been recommended as a general measure in percutaneous endoscopic gastrostomy to reduce the risk of peristomal wound infection 4. The use of antibiotic prophylaxis, such as cefotaxime and clindamycin, has been shown to be effective in reducing the incidence of site infection 3, 4.
Microbiology of PEG Tube Infections
The most common organisms isolated from PEG tube insertion site infections include:
- Candida species
- Staphylococcus aureus
- Pseudomonas aeruginosa 5, 6 These organisms are often susceptible to commonly used antimicrobial agents, although some quinolone-resistant and multidrug-resistant organisms have been isolated 5.
Prevention of PEG Site Infections
Prevention of PEG site infections is crucial, and educating patients on wound care practices can play a significant role in preventing these infections 6. Regular follow-up, provision of pre-discharge instructions, and programmed tube changes can also help prevent complications associated with PEG tubes 2.