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Mondorf A, Amini C, Graf C, Michael FA, Blumenstein I, Jung M, Friedrich-Rust M, Hack D, Besier SM, Hogardt M, Kempf VAJ, Zeuzem S, Welsch C, Bojunga J. Risk Factors and Role of Antibiotic Prophylaxis for Wound Infections after Percutaneous Endoscopic Gastrostomy. J Clin Med 2023; 12:jcm12093175. [PMID: 37176616 PMCID: PMC10179185 DOI: 10.3390/jcm12093175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND AND STUDY AIM The incidence of wound infections after percutaneous endoscopic gastrostomy (PEG) varies widely in recent studies. The present study systematically investigates the underlying risk factors for the development of wound infections in a large cohort of patients over a long-term follow-up period. PATIENTS AND METHODS A retrospective cohort study of patients undergoing PEG insertion using either the pull or push technique was conducted and patients followed up for 3 years. Tube-related wound infections were identified, and pathogens regularly cultured from wound swabs. Adjusted analysis was performed via univariate and multivariate logistic regression analysis. RESULTS 616 patients were included in this study. A total of 25% percent of patients developed wound infections upon PEG tube insertion and 6.5% showed recurrent infections. Nicotine abuse (p = 0.01), previous ischemic stroke (p = 0.01) and head and neck cancer (p < 0.001) showed an increased risk for wound infection after PEG placement. Moreover, radio-chemotherapy was associated with the occurrence of wound infections (p < 0.001). Infection rates were similar between pull and push cohorts. The most common bacterial pathogen detected was Enterobacterales (19.2%). Staphylococcus aureus, Pseudomonas aeruginosa and enterococci were frequently detected in recurrent infection (14.2%, 11.4% and 9.6%, respectively). Antibiotic prophylaxis showed no effect on infection rates. CONCLUSIONS Wound infections after PEG placement are common and occasionally occur as recurrent infections. There is potential for improvement in everyday clinical practice, particularly regarding antibiotic prophylaxis in accordance with guidelines.
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Affiliation(s)
- Antonia Mondorf
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Clara Amini
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Christiana Graf
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Florian Alexander Michael
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Irina Blumenstein
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Michael Jung
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Mireen Friedrich-Rust
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Daniel Hack
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Silke M Besier
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Michael Hogardt
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Volkhard A J Kempf
- Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
- University Center of Competence for Infection Control of the State of Hesse, 60596 Frankfurt am Main, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Christoph Welsch
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
| | - Jörg Bojunga
- Department of Internal Medicine 1, Goethe University Hospital Frankfurt, Goethe-University, 60596 Frankfurt am Main, Germany
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Boeykens K, Duysburgh I, Verlinden W. Prevention and management of minor complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol 2022; 9:e000975. [PMID: 35851280 PMCID: PMC9297220 DOI: 10.1136/bmjgast-2022-000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) was developed by Ponsky-Gauderer in the early 1980s. These tubes are placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition but can also be used for drainage or decompression. The tubes consist of an internal and external retention device. It is a generally safe technique but major or minor complications may arise during and after tube placement. METHOD A narrative review of the literature investigating minor complications after PEG placement. RESULTS This review was written from a clinical viewpoint focusing on prevention and management of minor complications and documented with real cases from more than 21 years of clinical practice. CONCLUSIONS Depending on the literature the incidence of minor complications after gastrostomy placement can be high. To decrease associated morbidity, prevention, early recognition and popper management of these complications are important.
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