Percutaneous endoscopic gastrostomy sites infected by methicillin-resistant Staphylococcus aureus: impact on outcome.
BACKGROUND
The impact of methicillin-resistant Staphylococcus aureus (MRSA) colonization of percutaneous endoscopic gastrostomy (PEG) sites on morbidity and mortality is uncertain.


OBJECTIVE
We investigated the impact of known prior MRSA colonization on the incidence of symptomatic PEG site wound infection and mortality.


METHODS
Consecutive patients who had PEG tubes inserted recently at our hospital were identified. The presence or absence of MRSA colonization before PEG placement was noted. Patients were observed for wound infection, and swabs were taken from the site if there was clinical infection. Mortality within 30 days of PEG placement was determined.


RESULTS
A total of 83 patients underwent PEG placement; 23 (28%) of these patients had known MRSA colonization before PEG placement. Of these, 13 (57%) developed symptomatic MRSA infection of the PEG site. The remaining 60 patients (72%) had no known prior MRSA colonization. In these patients, 9 (15%) developed symptomatic MRSA infection of the PEG site. The overall incidence of wound infection was 37% (31) of the total undergoing PEG placement, of whom 71% (22) had developed MRSA infection. The mortality of those with symptomatic MRSA infection of the PEG site was 9% (2/22), whereas the mortality from non-MRSA-infected PEGs was 20% (12/61).


CONCLUSIONS
Patients with prior MRSA colonization had a significantly higher risk of developing symptomatic MRSA infection of the PEG site. However, there was still a significant risk (15%) of developing MRSA infection of the PEG site for patients with no known prior MRSA infection. MRSA infection of the PEG site did not affect mortality.
Mainie
Inder
I
Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, N. Ireland, United Kingdom. mainie@musc.edu
Loughrey
Anne
A
Watson
Jennifer
J
Tham
Tony C K
TC
D000293:Adolescent; D000368:Aged; D002561:Cerebrovascular Disorders / Q000628:therapy; D016009:Chi-Square Distribution; D003680:Deglutition Disorders / Q000628:therapy; D003704:Dementia; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013203:Staphylococcal Infections; D013211:Staphylococcus aureus; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality