Administration of intravenous antibiotics before placement of a percutaneous endoscopic gastrostomy (PEG) tube reduces infection at the site

Lipp A, Lusardi G

Published Online:

March 16, 2011

Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure for inserting a feeding tube that goes into the stomach (through the abdomen) of patients who cannot take food by mouth. Antibiotics are often given intravenously before this surgical procedure, as a precaution to reduce the risk of infection at the site of operation. Twelve research studies were included in this review, and they confirm that those people who were given antibiotics when their PEG tube was inserted were less likely to suffer an infection at the site than those who were not given antibiotics.

Abstract (click to read)

Background:

Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure performed to maintain nutrition in the short- or long-term. During the procedure, a feeding tube that delivers either a liquid diet, or medication, via a clean or sterile delivery system, is placed surgically through the anterior abdominal wall. Those undergoing PEG tube placement are often vulnerable to infection because of age, compromised nutritional intake, immunosuppression, or underlying disease processes such as malignancy and diabetes mellitus. The increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) contributes both an additional risk to the placement procedure, and to the debate surrounding antibiotic prophylaxis for PEG tube placement. The aim of surgical antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient's serum and tissues, via a brief course of an appropriate agent, by the time of PEG tube placement in order to prevent any peristomal infections that might result from the procedure.

Objectives:

To establish whether prophylactic use of systemic antimicrobials reduces the risk of peristomal infection in people undergoing placement of percutaneous endoscopic gastrostomy tubes.

Search strategy:

For this second update, we searched the Cochrane Wounds Group Specialised Register (searched 16 February 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1); Ovid MEDLINE (1950 to February Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations February 15, 2011); Ovid EMBASE (1980 to 2011 Week 06); and EBSCO CINAHL (1982 to 11 February 2011).

Selection criteria:

Randomised controlled trials (RCTs) evaluating the use of prophylactic antimicrobials during PEG tube placement, with no restrictions regarding language of publication, date of publication, or publication status.

Data collection and analysis:

Both authors extracted data and assessed study quality. Meta-analyses were performed where appropriate.

Main results:

One new trial was identified and included in this update, bringing the total to 12 eligible RCTs, with a total of 1271 patients. All trials reported peristomal infection as an outcome, and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (1271 patients pooled: OR 0.36, 95% CI 0.26 to 0.50).

Authors' conclusions:

Administration of systemic prophylactic antibiotics for PEG tube placement reduces peristomal infection.

This record should be cited as:

Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD005571. DOI: 10.1002/14651858.CD005571.pub2

Assessed as up to date:

February 16, 2011

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Primary Review Group:

Wounds Group

Health topics:

Wounds > Surgical wounds > Infection control

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Administration of intravenous antibiotics before placement of a percutaneous endoscopic gastrostomy (PEG) tube reduces infection at the site

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