Antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG)--results from a prospective randomized multicenter trial.
OBJECTIVE
To determine the efficacy of antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG) as a part of a standardized regimen.


METHODS
An open prospective randomised multicenter study in 216 patients. 106 received ceftriaxone 1 g i.v. 30 min preinterventionally and 110 no study medication. A standardized protocol was followed for PEG preparation, insertion, and aftercare; all patients received a 15 French 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 23.6% on day 4 and 24.5% on day 10 vs. 7.6% (p < 0.05) and 11.4% (p < 0.05), respectively, in prophylaxis patients. Results were disproportionally better in tumor patients in comparison with neurological patients. Patients systemic infection rates were 11.8% vs. 1.9% in noprophylaxis vs. prophylaxis (p < 0.05), and overall infection rates 36.3% vs. 13.3%, respectively (p < 0.05). Pneumonia was more frequent in patients with underlying neurological disease and reduced in the prophylaxis group. Antibiotic and application costs were similar in both groups (p = 0.400).


CONCLUSIONS
Single-dose ceftriaxone 1 g is a effective prophylaxis against local and systemic infection after PEG and should be a part of a standard regimen.
Dormann
A J
AJ
German PEG Multicenter Trial Group, Medizinische Klinik, Klinikum Minden.
Wigginghaus
B
B
Risius
H
H
Kleimann
F
F
Kloppenborg
A
A
Rosemann
J
J
Padel
Y
Y
Pohl
R
R
Baum
H H
HH
Lübbesmeier
A
A
Schwab
J
J
Kühlkamp
V
V
Gutjahr
W
W
Lindenburger
W
W
Schütz
H
H
Huchzermeyer
H
H
D000368:Aged; D019072:Antibiotic Prophylaxis; D002443:Ceftriaxone / Q000008:administration & dosage*; D003428:Cross Infection / Q000517:prevention & control*; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D002443:Ceftriaxone