title: Prevention of percutaneous endoscopic gastrostomy site infections caused by methicillin-resistant Staphylococcus aureus.
abstract: Percutaneous endoscopic gastrostomy (PEG) is widely used to maintain enteral nutrition in patients who are unable to swallow. Peristomal wound infection is the most common complication of this procedure. In a hospital endemic for methicillin-resistant Staphylococcus aureus (MRSA), MRSA can be the most common organism associated with these infections. We have evaluated a strategy consisting of screening, skin decontamination and glycopeptide prophylaxis for preventing PEG-site infections. None of the 34 patients who received the decontamination protocol and glycopeptide prophylaxis (Group A) developed PEG-site infections within one month of surveillance. Two patients were infected with MRSA after that period. One of seven patients who received the decontamination protocol alone (Group B) was infected within the period of surveillance, while another patient was infected after that period. Both were infected with MRSA. None of nine patients who received glycopeptide prophylaxis alone (Group C) were infected. The results suggest that the strategy of screening, decontamination and glycopeptide prophylaxis is effective in the prevention of PEG-site infections with MRSA. Further trials are necessary to confirm these findings.
authors.affiliation: Department of Infection Control, University Hospital Lewisham, London SE13 6LH, UK. gopal.rao@uhl.nhs.uk
authors.forename: G Gopal
authors.initials: GG
authors.lastname: Rao
authors.forename: M
authors.initials: M
authors.lastname: Osman
authors.forename: L
authors.initials: L
authors.lastname: Johnson
authors.forename: D
authors.initials: D
authors.lastname: Ramsey
authors.forename: S
authors.initials: S
authors.lastname: Jones
authors.forename: H
authors.initials: H
authors.lastname: Fidler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002353:Carrier State / Q000175:diagnosis; D003666:Decontamination / Q000379:methods*; D004750:Enteral Nutrition; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy; D006020:Glycopeptides; D006801:Humans; D008297:Male; D008403:Mass Screening; D016106:Methicillin Resistance; D008875:Middle Aged; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides