Antibiotic prophylaxis tailored to local organisms reduces percutaneous gastrostomy site infection

Summary Background: Current recommendations for the choice of antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy (PEG) insertion may not be suitable in all situations. Aims: We sought to review the microbiology of PEG‐wound infections at our institution locally and observe PEG infection rates following a change in antibiotic policy. Methods: A retrospective clinical and microbiological review of all PEG‐wound infections resulted in a change in the choice of antibiotic. A further review was conducted 2 years later to examine the effect of this change. Results: PEG‐wound infection was detected in 33/103 (32.0%) patients between January 2002 and May 2004 with either second generation cephalosporins or co‐amoxiclav antibiotic prophylaxis, with the commonest organisms being Pseudomonas aeruginosa (16.7%), Klebsiella species (9.9%) and methicillin‐resistant Staphylococcus aureus (5.3%). Microbiological data revealed high levels of resistance to cefuroxime (60.7%) and co‐amoxiclav (51%). A change of prophylaxis to cefoperazone (during the period June 2004–May 2006) resulted in a reduction of PEG‐wound infections to 17/90 (18.9%) patients that required PEG tube insertion (p = 0.04). Together with a reduction in P. aeruginosa infections (18.4–10%, p = 0.10), a lower incidence of pyrexia (10.7% vs. 3.3%, p = 0.05), lower antibiotic administration (20.4% vs. 11.1%, p = 0.08) and lower rate of PEG removal (23.2% vs. 10.2%, p = 0.018) were noted following prophylaxis change. Conclusions: Antibiotic prophylaxis for PEG should be tailored to local organisms as this approach reduces the incidence and severity of peri‐stomal PEG infections.