title: Meta-analysis: antibiotic prophylaxis to prevent peristomal infection following percutaneous endoscopic gastrostomy.
abstract: BACKGROUND
  Despite numerous guidelines recommending prophylactic antibiotics prior to percutaneous endoscopic gastrostomy, their use remains controversial.
  
  
  OBJECTIVE
  To conduct a systematic literature review and performed meta-analyses to determine the benefit of antibiotic prophylaxis for percutaneous endoscopic gastrostomy placement.
  
  
  METHODS
  We performed a systematic literature review by searching healthcare databases and grey literature for randomized-controlled trials of antibiotic prophylaxis against wound infection after percutaneous endoscopic gastrostomy. Relative risks were calculated for individual trials and data pooled using fixed-effects model. Relative risk reduction, absolute risk reduction and number needed to treat were calculated and are reported with 95% confidence intervals.
  
  
  RESULTS
  Ten randomized-controlled trials met the inclusion criteria and 1059 cases were pooled. Overall findings indicated that antibiotic prophylaxis resulted in a relative risk reduction of 64% and an absolute risk reduction of 15%. Number needed to treat to prevent one wound infection was 8. Cephalosporin prophylaxis was associated with a relative risk reduction of 64%, absolute risk reduction of 10% and number needed to treat of 10, whereas penicillin-based prophylaxis was associated with a relative risk reduction of 62%, absolute risk reduction of 13% and number needed to treat of 8.
  
  
  CONCLUSIONS
  Antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy is effective in reducing the incidence of percutaneous endoscopic gastrostomy site wound infection. Based on sensitivity analyses, penicillin-based prophylaxis should be the prophylaxis of choice.
authors.affiliation: Division of Internal Medicine, Department of Medicine, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: N S
authors.initials: NS
authors.lastname: Jafri
authors.forename: S S
authors.initials: SS
authors.lastname: Mahid
authors.forename: K S
authors.initials: KS
authors.lastname: Minor
authors.forename: S R
authors.initials: SR
authors.lastname: Idstein
authors.forename: C A
authors.initials: CA
authors.lastname: Hornung
authors.forename: S
authors.initials: S
authors.lastname: Galandiuk
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002511:Cephalosporins / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010406:Penicillins / Q000627:therapeutic use*; D013530:Surgical Wound Infection / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins