Antibiotic prophylaxis does not reduce the infection rate following percutaneous endoscopic gastrostomy in infants and children

van, Anne L.; Driel, J Joris van; Kneepkens, CM Frank; Meij, Tim G. J. de

doi:10.1111/apa.13762

Cited by 13 publications

(14 citation statements)

References 26 publications

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“…A retrospective, single-center study that comprised 129 children aged up to 18 years with a median age of 2.9 years reported peristomal infections as the most frequent complication in 10%. 18 In a report from nine tertiary centers on prospective clinical data collection from 239 children with a mean age of 6 years, percutaneous endoscopic gastrostomy tube implantation was conducted. The cumulative incidence of complications was 47.7% at 24 months.…”

Section: Discussionmentioning

confidence: 99%

“…The surgical methods used for gastrostomy differ across various centers. 18 19 20 21 22 23 24 However, with all techniques, a foreign body is left in the wound with either stitches or T-fasteners used to anchor the stomach to the anterior abdominal wall. In addition, the infant's clinical situation, periods of cardiac insufficiency, and various phases of treatment with cytostatic drugs may influence healing.…”

Section: Discussionmentioning

confidence: 99%

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Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants

Burman

Díaz

Viktorsdóttir

et al. 2019

Surg J

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Background Gastrostomy placement in children is one of the most frequently performed pediatric surgical procedures and laparoscopic-assisted gastrostomy (LAG) is the preferred technique. Wound infection after LAG has become a significant concern due to the emergence of antibiotic resistance. The aim of this study was to describe the frequency of wound infection after LAG in children younger than 2 years of age and to identify the associated risk factors and the bacterial species involved. Methods Information about wound infection, results from bacterial cultures, and type of antibiotic treatment used within 30 postoperative days after LAG were compiled for infants who underwent LAG from 2010 to 2017. A retrospective chart review was performed. Data was compiled from charts and from an electronic database containing prospectively collected data. A multivariate logistic analysis was used to explore potential risk factors. Preoperative antibiotic prophylaxis and postoperative local wound care were conducted according to standard procedures. Results The 141 included infants underwent surgery at a median age of 10 months (range: 1–24). Thirty-eight (27%) patients had a clinically determined wound infection, bacteria were cultured from 26/38 (69%), and 30/38 (79%) received antibiotic treatment. The median interval from surgery to detection of a clinical wound infection was 14 days (range: 4–30). The most common microbes discovered were skin bacteria Staphylococcus aureus or Streptococcus pyogenes, but respiratory and intestinal bacteria were also found. Multivariate logistic regression analysis revealed no independent risk factors for infection such as age, gender, or underlying diagnosis. Conclusion Infants have a high rate of postoperative clinical wound infection after LAG despite the use of preoperative antibiotic prophylaxis and intense local wound care. Gender, age at operation, and previous diagnoses were not found to be independent risk factors for wound infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants

Burman

Díaz

Viktorsdóttir

et al. 2019

Surg J

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“…Van Els et al 13 found that the major complication rate was 5.4% and minor complication rate was 17.8% in 129 infants and children with PEG and the most common detected peristomal infection (10%). In the same study, when compared to those who received antibiotics and those who did not receive antibiotics, they found less infection in the group that did not take antibiotics and showed that prophylactic antibiotics did not reduce infectious complications 13 . However, the use of protective antibiotics is recommended in recent guidelines 14 .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic gastrostomy experience in children and family satisfaction

Canan

2019

Cukurova Medical Journal

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The aim of this study was to evaluate the demographic data, complication rates of children who underwent percutaneous endoscopic gastrostomy (PEG) and to question family satisfaction. Materials and Methods: Demographic information, underlying diseases, anthropometric measurements before and after PEG and z scores advanced complications due to processing and follow-up periods were obtained from patient files. Results: In three years, 21 patients underwent PEG procedures. The median age of the patients was 74 months. The majority of the cases consisted of children with neurological, oncological and metabolic diseases (71.4%, 14.3% and 14.3%, respectively). There was a statistically significant increase between baseline and 6th month and between baseline and 12th month of the all antropometric measures z scores. But no significant difference was observed between 6th month and 12th month of the median weight and height z scores. Parents' opinions about PEG were positive. After the procedure, one patient had ostomy leakage and three patients had local stoma infection. Conclusion: Percutaneous endoscopic gastrostomy is a very successful and reliable method in children and adolescents as well as in infants. Families' opinions on PEG after the procedure were positive. Amaç: Bu çalışmada perkütan endoskopik gastrostomi (PEG) işlemi uygulanmış çocukların demografik verilerinin, komplikasyon oranlarının irdelenmesi ve aile memnuniyetinin sorgulanması amaçlanmıştır. Gereç ve Yöntem: Hasta dökümanlarından demografik bilgiler, altta yatan hastalık, PEG öncesi ve sonrası antropometrik ölçümler ve z skorları, PEG'e bağlı komplikasyonlar ile izlem süresi kaydedildi. Bulgular: Üç yıl içinde 21 hastaya PEG işlemi gerçekleştirilmişti. Olguların ortanca yaşı 74 ay idi. Olguların çoğunluğunu nörolojik, onkolojik ve metabolik hastalığı olan çocuklar oluşturmaktaydı (sırasıyla %71.4, %14.3 ve %14.3). Hastaların başlangıç ile 6.ay, 6-12. ay ve başlangıç ile 12.ay arasındaki tüm antropometrik ölçümlerinde istatistiksel olarak anlamlı artışı bulundu. Ancak 6-12.ay arasında boy ve kilo ortanca z skorları karşılaştırıldığında anlamlı yükseklik gözlenmedi). Ebeveynlerin işlem sonrası PEG ile ilgili görüşleri olumlu idi. İşlem sonrasında bir hastada ostomi sızıntısı ve üç hastada yerel stoma enfeksiyonu geliştiği tesbit edildi. Sonuç: Perkütan endoskopik gastrostomi, çocuklarda ve ergenlerde olduğu gibi, süt çocuklarında da oldukça başarılı ve güvenilir bir yöntemdir. Ailelerin işlem sonrası perkütan endoskopik gastrostomi ile ilgili görüşleri olumludur.

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“…A Cochrane meta-analysis of adults (not on PD) undergoing PEG placement showed that prophylactic antibiotics decreased gastrostomy exit site infection [56]. However, in a single-center retrospective study of children, again not on PD, antibiotic prophylaxis did not decrease the risk of infectious complications [57].…”

Section: Evidence and Rationalementioning

confidence: 99%

“…Given the high dextrose content of dialysate and the potential for bacterial contamination of the peritoneum at the time of gastrostomy placement, we strongly recommend antibiotic and antifungal prophylaxis to lower the risk of peritonitis in children already on PD at the time of gastrostomy insertion. On the basis of a Cochrane review [56], ESPGHAN [5,59] recommend pre-operative antibiotic prophylaxis to reduce stomal infection rates, but do not comment on the type, timing or duration of antibiotic prophylaxis either for children on PD, or when PD and gastrostomy tubes are inserted simultaneously. ISPD [47] guidelines recommend using a single dose of cefazolin (or vancomycin if MRSA risk is high).…”

Section: Evidence and Rationalementioning

confidence: 99%

Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

et al. 2020

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The nutritional prescription (whether in the form of food or liquid formulas) may be taken orally when a child has the capacity for spontaneous intake by mouth, but may need to be administered partially or completely by nasogastric tube or gastrostomy device ("enteral tube feeding"). The relative use of each of these methods varies both within and between countries. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) based on evidence where available, or on the expert opinion of the Taskforce members, using a Delphi process to seek consensus from the wider community of experts in the field. We present CPRs for delivery of the nutritional prescription via enteral tube feeding to children with chronic kidney disease stages 2-5 and on dialysis. We address the types of enteral feeding tubes, when they should be used, placement techniques, recommendations and contraindications for their use, and evidence for their effects on growth parameters. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgement. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.

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Antibiotic prophylaxis does not reduce the infection rate following percutaneous endoscopic gastrostomy in infants and children

Abstract: Percutaneous endoscopic gastrostomy was a safe procedure and antibiotic prophylaxis did not seem to decrease infectious complications.

Cited by 13 publications

References 26 publications

Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants

Wound Infection after Laparoscopic-Assisted Gastrostomy in Infants

Percutaneous endoscopic gastrostomy experience in children and family satisfaction

Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2–5 and on dialysis—clinical practice recommendations from the Pediatric Renal Nutrition Taskforce

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