A single dose of ceftriaxone administered 30 minutes before percutaneous endoscopic gastrostomy significantly reduces local and systemic infective complications.
OBJECTIVE
The aim of this study was to determine the efficacy of antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG).


METHODS
An open prospective, randomised, multicenter study was conducted in 141 patients; 72 received ceftriaxone 1 g i.v. 30 min preintervention, and 69 received no study medication. A standardized protocol was followed for PEG preparation, insertion, and aftercare; all patients received a 15-Fr gastrostomy tube. Follow-up of local and systemic infection and clinical course was continued to postintervention day 10. An aggregate erythema and exudation score >3 or the presence of pus was taken as indicative of peristomal infection. The pharmacoeconomics of antibiotic use were also examined.


RESULTS
In no-prophylaxis patients, wound infection rates were 25% on day 4 and 26.4% on day 10, versus 10.1% (p = 0.03) and 14.5% (p = 0.10), respectively, in prophylaxis patients. Results were disproportionally better in tumor patients: systemic infection rates were 16.7% versus 5.8% in no-prophylaxis versus prophylaxis patients (p = 0.045), and overall infection rates 38.9% versus 17.4%, respectively (p = 0.046). Pneumonia was more frequent in patients with underlying neurological disease. Antibiotic costs were the same in both groups (p = 0.792).


CONCLUSIONS
Single dose ceftriaxone 1 g is an effective prophylaxis against local and systemic infection after PEG.
Dormann
A J
AJ
Department of Internal Medicine, Klinikum Minden, Germany.
Wigginghaus
B
B
Risius
H
H
Kleimann
F
F
Kloppenborg
A
A
Grünewald
T
T
Huchzermeyer
H
H
D000368:Aged; D019072:Antibiotic Prophylaxis / Q000191:economics; D016470:Bacteremia / Q000209:etiology; D002443:Ceftriaxone / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D004750:Enteral Nutrition / Q000295:instrumentation; D004890:Erythema / Q000209:etiology; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications; D009422:Nervous System Diseases / Q000150:complications; D011014:Pneumonia / Q000209:etiology; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D013492:Suppuration; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*
D002511:Cephalosporins; D002443:Ceftriaxone