Treatment of Gastrostomy Tube Infection
For suspected or diagnosed G-tube site infection, apply topical antimicrobial agents to the entry site and surrounding tissue combined with systemic broad-spectrum antibiotics; if infection persists despite this approach, remove the tube. 1
Initial Assessment and Risk Factors
When evaluating a G-tube infection, recognize that patients with diabetes, obesity, poor nutritional status, and those on chronic corticosteroid or immunosuppressive therapy are at increased risk. 1 Look specifically for:
- Loss of skin integrity at the insertion site 1
- Erythema and purulent or malodorous exudate 1
- Fever and localized pain 1
- Ensure the external bolster is not too tight, causing excessive pressure 1
Microbiological Profile
The most common bacterial pathogens isolated from G-tube infections are:
- Staphylococcus aureus (21.3% of cases) 2
- Pseudomonas aeruginosa (13.1% of cases) 2
- Escherichia coli (9.8% of cases) 2
- Candida species (frequently isolated in cancer patients) 3
Polymicrobial infections occur in approximately 47% of cases. 3 Multidrug-resistant organisms are present in approximately 3% of infections. 2
Treatment Algorithm
Step 1: Local Antimicrobial Therapy
- Swab the area for both bacterial and fungal culture before initiating treatment 1
- Apply antimicrobial dressings with sustained-release agents (silver, iodine, or polyhexamethylene biguanide) available as foams, hydrocolloids, or alginates 1
- Do not use topical antibiotics 1
- Be aware of allergies to dressing components; silver dressings cannot be worn during MRI procedures 1
Step 2: Systemic Antibiotic Therapy
Given the polymicrobial nature and common pathogens, empiric broad-spectrum coverage should target:
- Gram-positive coverage (particularly S. aureus): Consider vancomycin or cephalosporins 2, 3
- Gram-negative coverage (particularly P. aeruginosa and E. coli): Fluoroquinolones or third-generation cephalosporins 2, 3
- Anaerobic coverage if deep tissue involvement suspected 1
One effective prophylactic regimen demonstrated in the literature combines clindamycin 600 mg plus cefotaxime 1,000 mg every 8 hours, which reduced infection rates to 3.1% within 48 hours and 1.0% within 7 days. 4 This combination provides excellent coverage for the typical pathogens.
Step 3: Antifungal Therapy
If fungal infection is proven (particularly with silicone tubes in situ), add tailored systemic antifungal agents. 1
Step 4: Tube Removal Indications
Remove and/or replace the gastrostomy tube if: 1
- Stoma tract disruption occurs
- Peristomal infection persists despite appropriate antimicrobial treatment
- Skin excoriation develops
- Fungal infection is present (especially with silicone tubes)
Common Pitfalls to Avoid
- Do not use topical antibiotics alone—they are ineffective and not recommended 1
- Do not delay systemic antibiotics when signs of infection are present 1
- Do not ignore fungal pathogens, particularly in immunocompromised or cancer patients where Candida species are common 3
- Do not overlook the external bolster tension, as excessive pressure promotes infection 1
- Most infections are local (cellulitis, skin and soft tissue infections, abdominal wall abscess) without bacteremia, but serious complications including peritonitis and deep abscesses can occur requiring parenteral antibiotics and prolonged hospitalization 5