Peristomal infection after percutaneous endoscopic gastrostomy: a 7-year surveillance of 297 patients / Infecção peristomal na gastrostomia endoscópica percutânea: estudo de 297 doentes gastrostomizados ao longo de 7 anos

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.

CONTEXTO: As infeções associadas aos cuidados de saúde constituem o mais frequente efeito adverso observado durante a prestação de cuidados de saúde. Os avanços clínicos como a gastrostomia endoscópica percutânea melhoraram a qualidade de vida dos doentes mas trouxeram um risco acrescido de infeções associadas aos cuidados de saúde. Os fatores de risco para a infecção peristomal são pouco conhecidos, mas a profilaxia antibiótica e outras estratégias profiláticas parecem reduzir a infeção peristomal. OBJETIVOS: O objetivo primário foi a avaliação global da taxa de infecção peristomal e a caracterização microbiológica dos agentes infetantes. Foram objetivos secundários a avaliação do protocolo de profilaxia antibiótica utilizado e a identificação de potenciais fatores de risco para a infeção peristomal. MÉTODO: Estudo retrospetivo em doentes submetidos a gastrostomia endoscópica entre janeiro de 2004 e setembro de 2010. Os doentes receberam profilaxia antibiótica com cefazolina antes do procedimento. Os processos clínicos foram revistos obtendo-se os dados demográficos, diagnóstico da doença subjacente e potenciais fatores de risco para infeção. A análise estatística foi feita com recurso ao programa SPSS 17.0. RESULTADOS: Foram gastrostomizados 297 doentes adultos. A infeção peristomal afetou 36 doentes (12,1%). O Staphylococcus aureus resistente à metacilina foi o micro-organismo mais frequentemente isolado (33,3%) seguido pela Pseudomonas aeruginosa (30,6%). A incidência de infeção peristomal aumentou progressivamente ao longo dos anos de 4,65% em 2004/2007 até 17,9% em 2008/2010. Este achado foi consistente com o crescimento global da infeção hospitalar. A maioria das infeções peristomais (55,6%) foi identificada nos primeiros 10 dias após a gastrostomia. Não encontramos diferenças significativas na prevalência da infeção peristomal relacionáveis com a idade, índice de massa corporal, sobrevida e duração da nutrição por gastrostomia endoscópica percutânea. Fatores institucionais, como a prevalência global da infeção hospitalar e o caráter endêmico do MRSA, são importantes na infeção peristomal e a profilaxia tradicional com cefazolina não é adequada num contexto de elevada prevalência de micro-organismos resistentes. CONCLUSÕES: A infeção peristomal é um problema frequente e clinicamente significativo que deve ser encarado como infeção associada aos cuidados de saúde. A profilaxia usando cefalosporinas pode não ser adequada e deve ser revista em hospitais e outras instituições com elevada prevalência de micro-organismos resistentes.

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

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.