What is the treatment for stoma site infection?

Treatment of Stoma Site Infection

The treatment of stoma site infection involves topical antimicrobial agents as first-line therapy, followed by systemic broad-spectrum antibiotics if the infection doesn't resolve with topical treatment alone. 1

Initial Assessment and Diagnosis

• Look for signs and symptoms of infection including loss of skin integrity, erythema, purulent and/or malodorous exudate, fever, and pain 1
• Swab the area for both bacterial and fungal culture to guide targeted therapy 1
• Ensure the external bolster is not too tight, as excessive pressure between internal and external bolsters is associated with higher infection rates 1

Treatment Algorithm

First-Line Treatment:

• Apply a topical antimicrobial agent to the entry site of the tube and surrounding tissue 1
• Options include:
  • Antimicrobial ointment (non-antibiotic) 1
  • Dressings with sustained-release antimicrobial agents (silver, iodine, or polyhexamethylene biguanide) 1
  • Available in various forms: foams, hydrocolloids, or alginates 1

Second-Line Treatment:

• If the infection doesn't resolve with topical treatment, add systemic broad-spectrum antibiotics 1
• For minor infections: oral broad-spectrum antibiotics for 5-7 days 1
• For more severe infections with systemic signs: intravenous broad-spectrum antibiotics coupled with local wound care 1

For Fungal Infections:

• Local fungal skin infections associated with stoma leakage should be treated with topical antifungal agents 1
• If proven fungal infection persists, systemic antifungal agents may be required 1

Refractory Cases:

• If the infection cannot be resolved with the above treatments, the tube should be removed 1
• In some cases, the tube must be removed for several days to allow the stoma to heal 1
• Occasionally, a repeat gastrostomy may need to be placed at a new site 1

Additional Wound Care Measures

• Clean the stoma site at least once daily using an antimicrobial cleanser 1
• For well-established stomas (after approximately one week), clean twice weekly with fresh tap water and soap, then thoroughly dry 1
• Apply stoma adhesive powder or zinc oxide to prevent local skin irritation 1
• Use foam dressings rather than gauze to reduce local skin irritation (foam lifts drainage away from skin, whereas gauze tends to trap it) 1
• Avoid occlusive dressings as they promote a moist wound environment and can lead to skin maceration 1

Special Considerations

• High-risk patients for stoma site infections include those with diabetes, obesity, poor nutritional status, and those on chronic corticosteroid or other immunosuppressive therapy 1
• Ensure proper positioning of the external bolster with approximately 1 cm of play between the skin and external bolster to maintain proper tension and decrease likelihood of complications 1
• Topical antibiotics should not be used (as opposed to other antimicrobial agents) 1
• Wound and ostomy nurses are valuable resources in managing infected stoma sites 1

Warning Signs Requiring Urgent Intervention

• If a patient with local site infection develops signs of peritonitis, surgical intervention may be required 1
• Persistent infection despite appropriate antimicrobial treatment, stoma tract disruption, or severe skin excoriation may necessitate tube removal and replacement 1