Antibiotic prophylaxis tailored to local organisms reduces percutaneous gastrostomy site infection

Current recommendations for the choice of antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy (PEG) insertion may not be suitable in all situations. We sought to review the microbiology of PEG-wound infections at our institution locally and observe PEG infection rates following a change in antibiotic policy. A retrospective clinical and microbiological review of all PEG-wound infections resulted in a change in the choice of antibiotic. A further review was conducted 2 years later to examine the effect of this change. PEG-wound infection was detected in 33/103 (32.0%) patients between January 2002 and May 2004 with either second generation cephalosporins or co-amoxiclav antibiotic prophylaxis, with the commonest organisms being Pseudomonas aeruginosa (16.7%), Klebsiella species (9.9%) and methicillin-resistant Staphylococcus aureus (5.3%). Microbiological data revealed high levels of resistance to cefuroxime (60.7%) and co-amoxiclav (51%). A change of prophylaxis to cefoperazone (during the period June 2004-May 2006) resulted in a reduction of PEG-wound infections to 17/90 (18.9%) patients that required PEG tube insertion (p = 0.04). Together with a reduction in P. aeruginosa infections (18.4-10%, p = 0.10), a lower incidence of pyrexia (10.7% vs. 3.3%, p = 0.05), lower antibiotic administration (20.4% vs. 11.1%, p = 0.08) and lower rate of PEG removal (23.2% vs. 10.2%, p = 0.018) were noted following prophylaxis change. Antibiotic prophylaxis for PEG should be tailored to local organisms as this approach reduces the incidence and severity of peri-stomal PEG infections.