Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG) -: results from a prospective randomized multicenter trial

Objective: To determine the efficacy of antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG) as a part of a standardized regimen. Methods: An open prospective randomised multicenter study in 216 patients. 106 received ceftriaxone 1 g i. v 30 min preinterventionally: and 110 no study medication. A standardized protocol was followed for PEG preparation, insertion, and aftercare; all patients received a 15 French gastrostomy tube. Followup of local and systemic infection and clinical course was continued to postintervention day 10. An aggregate erythema and exudation score > 3 or die presence of pus was taken as indicative of peristomal infection. The pharmacoeconomics of antibiotic use were also examined. Results: In no-prophylaxia patients, wound infection rates were 23.6% on day 4 and 24.5% on day 10 vs. 7.6% (p < 0.05) and 11.4 % (p = 0.05), respectively, in prophylaxis patients. Results were disproportionally better in tumor patients in comparison with neurological patients, Patients systemic infection rates were 11.8% vs. 1.9% in no prophylaxis vs. prophylaxis (p < 0.05), and overall infection rates 36.3% vs. 13.3%. respectively (p < 0.05). Pneumonia was more frequent in patients with underlying neurological disease and reduced in the prophylaxis group. Antibiotic and application costs were similar in both groups (p = 0.400). Conclusions: Single-dose ceftriaxone 1 g is a effective prophylaxis against local and systemic infection after PEG and should be a part of a standard regimen.