Is it safe to replace a G-tube (gastrostomy tube) in a patient with a Staph (Staphylococcus) infection?

G-Tube Replacement in the Setting of Staphylococcus Infection

G-tube replacement should be delayed until active staphylococcal infection is treated with systemic broad-spectrum antibiotics, particularly in high-risk patients, though replacement can proceed safely in the absence of active infection even with prior staph colonization. 1

Risk Assessment Before Replacement

The decision to replace a G-tube depends critically on whether there is active infection versus prior colonization:

• Active stoma site infection occurs in approximately 15% of cases after transoral gastrostomy placement, with staphylococci being among the most common infecting organisms alongside gram-negative bacteria and yeast 2
• Most G-tube infections remain localized to the stoma site and do not progress to bacteremia when treated appropriately 1, 3
• The overall infection rate in community hospital settings is documented at 4.8%, with serious complications (peritonitis, deep abscesses) occurring rarely but requiring aggressive management 2

High-Risk Patients Requiring Extra Caution

Certain patient populations face elevated risk of bacteremia during G-tube manipulation and should have infections fully treated before elective replacement 1:

• Patients with diabetes mellitus 1, 4
• Patients with obesity 1, 4
• Patients with poor nutritional status 1, 4
• Patients on chronic corticosteroid therapy or other immunosuppressive treatment 1, 4
• Patients with excessive tension between internal and external bolsters causing tissue necrosis, which creates a direct portal for bacterial invasion into the bloodstream 1, 3

Pre-Replacement Assessment Algorithm

Before proceeding with G-tube replacement, systematically evaluate the stoma site 1, 4:

1. Examine for signs of active infection: loss of skin integrity, erythema, purulent or malodorous exudate, fever, and pain 5, 4
2. Swab the area for bacterial and fungal cultures before any manipulation if infection is suspected 1, 4
3. Check external bolster tension: ensure approximately 1 cm of play between the skin and external bolster to reduce tissue pressure and infection risk 1, 4
4. Assess for systemic signs: fever, signs of peritonitis, or persistent infection despite topical treatment 1, 4

Management Strategy Based on Infection Status

If Active Infection is Present

Treat the infection first before elective replacement 1:

• Apply topical antimicrobial agents (not topical antibiotics, which promote resistance) to the entry site and surrounding tissue 5, 3, 4
• Use antimicrobial ointments or sustained-release dressings with silver, iodine, or polyhexamethylene biguanide 1, 3
• Initiate systemic broad-spectrum antibiotics if the infection cannot be resolved with topical treatment alone 5
• Clean the stoma site at least once daily using an antimicrobial cleanser 5, 4

If Urgent Replacement is Required Despite Active Infection

When tube dysfunction necessitates immediate replacement in the setting of active infection 1:

• Obtain blood cultures before starting antibiotics if bacteremia is suspected 1
• Initiate intravenous broad-spectrum antibiotics covering Staphylococcus aureus, Pseudomonas, and gram-negative organisms 1
• Consider prophylactic antibiotics with first-generation cephalosporin or similar agent covering cutaneous organisms for the percutaneous procedure 1
• Perform replacement with strict aseptic technique 5

If No Active Infection is Present

Replacement can proceed safely even with history of prior staphylococcal colonization 5:

• Balloon-type replacement tubes are mostly used for blind replacement through the same matured tract 5
• The replacement can be performed endoscopically, radiologically, surgically, or at bedside depending upon the type of gastrostomy tube being replaced 5
• Most successfully replaced tubes (97%) can be placed in the emergency department setting without surgical assistance 6

Critical Pitfalls to Avoid

• Never use topical antibiotics as they promote resistance; instead use antimicrobial ointments or sustained-release dressings 1, 3
• Do not delay systemic antibiotics in patients with signs of bacteremia while waiting for culture results 1
• Do not ignore excessive bolster tension, as this creates tissue necrosis and a direct portal for bacterial invasion into the bloodstream 1, 3
• Do not proceed with elective replacement in high-risk patients with active infection without first treating the infection systemically 1, 4

Warning Signs Requiring Immediate Intervention

Recognize these signs that indicate potential bacteremia or serious infection 1, 4:

• Fever with systemic signs requires immediate blood cultures and intravenous broad-spectrum antibiotics 1
• Persistent or worsening local infection despite topical treatment requires systemic antibiotics 1, 4
• Signs of peritonitis require immediate intervention and may necessitate surgical consultation 1, 4
• Stoma tract disruption or severe skin excoriation may require tube removal and replacement at a different site 4