Clinical impact and risk factors for percutaneous gastrostomy wound infections due to resistant organisms

Mahadeva, Sanjiv; Khoo, B.-L.; Khoo, Peek-Swan; Malik, Abdul; Hilmi, Ida; Qua, Choon‐Seng; Wong, Choon-Heng; Goh, Khean‐Lee

doi:10.1016/j.ijid.2007.09.019

Cited by 4 publications

(5 citation statements)

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“…In previous series the rate of wound infection may differ significantly between 5% and 39% (13,14,21) . In our study, the overall peristomal infection rate was 12.1%, an intermediate figure, but rising every year and over 25% in 2010.…”

Section: Discussionmentioning

confidence: 86%

“…The increasing incidence of resistant organisms in hospitals and long term care facilities justifies, nowadays, the clinical impact of these infections (4,14) . In a hospital endemic for methicillin-resistant Staphylococcus aureus, MRSA can be the most common organism associated with peristomal infection (17) .…”

Section: Peristomal Infection After Percutaneous Endoscopic Gastrostomentioning

confidence: 99%

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Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Duarte

Santos

Capelas

et al. 2012

Arq. Gastroenterol.

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-Context -Healthcare-associated infection represents the most frequent adverse event during care delivery. Medical advances like percutaneous endoscopic gastrostomy have brought improvement on quality of life to patients but an increased risk of healthcare-associated infection. Predictive risk factors for peristomal wound infection are largely unknown but evidence suggests that antibiotic prophylaxis and preventive strategies related to infection control may reduce infection rates. Objectives -The primary aim was to evaluate the global prevalence rate of peristomal infection. Secondary objectives were to characterise the positive culture results, to evaluate the prophylactic antibiotic protocol and to identify potential risk factors for peristomal infection. Methods -Retrospective study of 297 patients with percutaneous endoscopic gastrostomy performed at a general hospital between January 2004 and September 2010. Patients received prophylactic cefazolin before the endoscopic gastrostomy procedure. Medical records were reviewed for demographic data, underling disease conditions to percutaneous endoscopic gastrostomy and patient potential intrinsic risk factors. Statistical analysis was made with the statistical program SPSS 17.0. Results -A total of 297 percutaneous endoscopic gastrostomy tubes were inserted. Wound infection occurred in 36 patients (12.1%). Staphylococcus aureus methicillin resistant was the most frequently isolated microorganism (33.3%) followed by Pseudomonas aeruginosa (30.6%). The incidence rate had been rising each year and differ from 4.65% in 2004/2007 to 17.9% in 2008/2010. This finding was consistent with the increasing of prevalence global infection rates of the hospital. Most of the infections (55.6%) were detected in the first 10 days post procedure. There was no significant difference in age, body mass index values, mean survival time and duration of percutaneous endoscopic gastrostomy feeding between patients with and without periostomal infection. Institutional factors, namely global prevalence infection rates and the endemic character of Staphylococcus aureus methicillin resistant, play an important role in peristomal infection rates. Traditional antibiotic prophylaxis with cefazolin is not adequate due to the prevalence of resistant organisms. Conclusions -Peristomal infection is a frequent problem with clinical impact in percutaneous endoscopic gastrostomy patients and should be considered a healthcare associated infection. The antimicrobial prophylaxis regimens using cephalosporins are not adequate and need to be reviewed due to the high prevalence of Staphylococcus aureus methicillin resistant and other resistant organisms in hospitals and nursing homes.

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Section: Discussionmentioning

confidence: 86%

Section: Peristomal Infection After Percutaneous Endoscopic Gastrostomentioning

confidence: 99%

Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Duarte

Santos

Capelas

et al. 2012

Arq. Gastroenterol.

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“…This study revealed that the most predominant resistant detected organism is Klebsiella (57.1%) while E Coli accounts for 28.6% and Proteus is 14.3%. Compared to results of the study of Sanjiv Mahadeva,et.al where resistant organisms detected at PEG tube site are Pseudomonas aeruginosa (38.0%), Klebsiella species ( 22.5%), methicillinsensitive Staphylococcus aureus (14.1%), and methicillin-resistant Staphylococcus aureus (11.3%) 16 . In particular, the percentage of…”

Section: Discussionmentioning

confidence: 59%

Multi Drug Resistant Bacteria and Its Antibiotic Susceptibility at Percutanous Endoscopic Gastrostomy (PEG) Tube Site of Long Term Care Facility Elderly Residents

Bedewy

Sabry²

2017

Egyptian Journal of Hospital Medicine

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Background: Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. The objective of this descriptive study was to detect the commonest multidrug resistant bacteria and its antibiotic sensitivity at PEG tube site of elderly residents at long term care facility (LTCF). Forty two long term care facility elderly residents bedridden were having multi drug resistant organisms at percutaneous endoscopic gastrostomy tube site. Informed consent taken from each patient or from his/her guardian, also Ethical committee approval was obtained. Demographic data were collected and comorbidities were established. Culture and sensitivity was done for pus samples from PEG tube site (stoma) and documented multidrug resistant organisms with antibiotic susceptibility to a range of different antibiotic groups. All samples were processed as per standard techniques and bacteria identified by standard biochemical tests. IBM SPSS statistics (version 24, IBM corp., USA, 2016) was used for data analysis. The age ranges from 60 to 79 years with mean 69.19 +/-7.01 years. 47.6 % of residents in the age group 60-66 y while 52.4% of residents are in the age group 67-80 y. Males were 57.1% while females were 42.9 %, The predominant resistant detected organism in this sample was Klebsiella (57.1%) while E coli accounts for 28.6% and Proteus is 14.3%. The study revealed that klebsiella was highly statistically significant sensitive to Cefepime (CPM), Imipenam (IMP), Ciprofloxacin (CP), and Colistin (CT) and statistically significant resistant to Trimethoprim/Sulfamethoxazole (TS), and tobramycin (tobra.) Whereas Proteus was highly statistically significant resistant to Cefepime (CPM), Colistin (CT), Imipenam (IMP) and highly statistically significant sensitive to Ciprofloxacin (CP), Trimethoprim/Sulfamethoxazole (TS), tobramycin (tobra.). E Coli was found to be highly statistically significant intermediately sensitive to Cefepime (CPM), Colistin (CT), and Tobramycin and highly statistically significant resistant to Ciprofloxacin (CP), Trimethoprim/Sulfamethoxazole (TS). Further studies are recommended on larger numbers of elderly patients to confirm significant findings in this study, try to explain these findings, and make use of them in clinical practice.

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“…A recent review of P. aeruginosa infection in this tertiary institution revealed it to be an increasingly common cause of bacteriaemia with a 26% mortality rate (15). We had additionally reported that P. aeruginosa infection of PEG wounds resulted in a significant morbidity and clinical burden in patients prior to the change in antibiotic prophylaxis (5). Cefoperazone was chosen as prophylaxis after June 2004 because of its broad spectrum cover, anti‐pseudomonal properties, lower resistance rates and its cost effectiveness (16).…”

Section: Discussionmentioning

confidence: 99%

“…Although PEG‐wound infections are not considered to be a major complication, their clinical impact and economic consequences can be considerable. We previously demonstrated that 67% of patients with PEG‐wound infections at our institution required additional antibiotic therapy and had a significantly longer duration of hospitalisation compared to patients without wound infections (5). Antibiotic prophylaxis before PEG placement is currently the most effective means of reducing peri‐stomal wound infections (6).…”

Section: Introductionmentioning

confidence: 91%

Antibiotic prophylaxis tailored to local organisms reduces percutaneous gastrostomy site infection

Mahadeva

Sam

Khoo

et al. 2009

International Journal of Clinical Practice

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Clinical impact and risk factors for percutaneous gastrostomy wound infections due to resistant organisms

Cited by 4 publications

References 5 publications

Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients

Multi Drug Resistant Bacteria and Its Antibiotic Susceptibility at Percutanous Endoscopic Gastrostomy (PEG) Tube Site of Long Term Care Facility Elderly Residents

Antibiotic prophylaxis tailored to local organisms reduces percutaneous gastrostomy site infection

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