Methicillin‐resistant Staphylococcus aureus infection of percutaneous endoscopic gastrostomy sites

Abstract

Background: Antibiotic prophylaxis for percutaneous endoscopic gastrostomy insertion remains controversial. The bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion has been poorly studied, leading to uncertainty regarding the optimum choice of antibiotic for prophylaxis. Aim: To investigate the bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion and to determine the contribution of methicillin‐resistant Staphylococcus aureus. Methods: Nasal and pharyngeal swabs were taken from a consecutive series of patients prior to percutaneous endoscopic gastrostomy insertion over a 6‐month period. Bacterial colonization and infection at the peristomal site were prospectively evaluated at days 2/3 and 7 post‐insertion. Results: Thirty‐one patients underwent percutaneous endoscopic gastrostomy insertion (mean age, 68 years; cerebrovascular disease, 52%). Naso‐pharyngeal colonization by methicillin‐resistant Staphylococcus aureus (35%) invariably led to peristomal colonization following percutaneous endoscopic gastrostomy insertion. Peristomal infection occurred in eight (26%) cases (seven (88%) methicillin‐resistant Staphylococcus aureus‐ positive). Peristomal infection was significantly more likely to occur in patients with naso‐pharyngeal methicillin‐resistant Staphylococcus aureus colonization (odds ratio, 10.8; 95% confidence interval, 1.6–70.9). Conclusions: Naso‐pharyngeal methicillin‐resistant Staphylococcus aureus colonization invariably predicts peristomal methicillin‐resistant Staphylococcus aureus colonization following percutaneous endoscopic gastrostomy insertion, and is associated with an increased peristomal infection rate. Currently recommended antibiotic prophylaxis regimens may be inappropriate in institutions with significant methicillin‐resistant Staphylococcus aureus colonization rates.

Successful Control of Peristomal Infection by Introducer-Type Percutaneous Endoscopic Gastrostomy: A Retrospective Historical Control Study

“…Our results also showed that most of the bacteria isolated were flora found in the oral cavity. Consistent with the results of previous studies [13][14][15][16], MRSA was the major pathogen of PEG-site infections in our study. Thus, current guidelines that recommend antibiotic prophylaxis may be inappropriate for control of infection after PEG insertion [7,8].…”

High Rate of Percutaneous Endoscopic Gastrostomy Site Infections Due to Oropharyngeal Colonization

“…More recent studies [7][8][9][10] have shown the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a major pathogen of PEG site infections and raised the question whether the currently recommended prophylactic antibiotics are appropriate [10]. There is also no agreement about the proper use of antibiotic prophylaxis prior to PEG placement in different patient populations.…”

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

“…In 2011 The Infectious Diseases Society of America published the first guidelines for the treatment of MRSA infections in hospitals and ambulatory settings, which was an important step in the elaboration of new prophylactic and therapeutic protocols in health institutions (11) . A cephalosporin-based prophylaxis is usually suggested to decrease peristomal infection after PEG insertion (2,18) but these antibiotics are unlikely to be useful in the prevention of PEG-site infections caused by MRSA and resistant strains of Pseudomonas aeruginosa (9) . A recent paper in the British Medical Journal (BMJ) suggested the use of co-trimoxazol in the PEG prophylaxis (3) .…”