title: Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors.
abstract: BACKGROUND
  Due to its high efficacy and technical simplicity, percutaneous endoscopic gastrostomy (PEG) has gained wide-spread use. Local infection, occurring in approximately 2% to 39% of procedures, is the most common complication in the short term. Risk factors for local infection are largely unknown and therefore--apart from calculated antibiotic prophylaxis--preventive strategies have yet to be determined.
  
  
  OBJECTIVE
  To assess the potential patient- and procedure-related risk factors for peristomal infection following PEG tube placement.
  
  
  METHODS
  Potential patient-related (eg, age, sex, diseases, body mass index, concomitant antibiotic therapy) and procedure-related (endoscopist experience, institutional factors, findings on endoscopy) risk factors and their coincidence with local infection, defined as a positive peristomal infection three days after PEG tube placement, were evaluated at two institutions. A standardized antibiotic prophylaxis was not performed. The peristomal infection score was also evaluated in 390 patients.
  
  
  RESULTS
  Using a multivariate binary regression analysis, four risk factors were established as relevant for local infection after PEG: clinical institution (OR 6.69; P = 0.0001), size of PEG tubes (15 Fr versus 9 Fr; OR 2.12; P = 0.05), experience of the endoscopist (more than 100 investigations versus less than 100 investigations; OR 0.54; P = 0.05) and the existence of a malignant underlying disease (OR 2.28; P = 0.019).
  
  
  CONCLUSIONS
  Similar to other endoscopic interventions, local infection as a complication of PEG tube placement depends on the experience of the endoscopist. Institutional factors also play a significant role. Additional risk factors include PEG tube size and underlying diseases. These findings indicate that the local infection after PEG tube placement may be influenced by both endoscopy-associated factors and by the underlying disease status of the patient.
authors.affiliation: Department of Medicine, Friedrich-Alexander-University, Erlangen, Germany. yurdaguel.zopf@uk-erlangen.de
authors.forename: Y
authors.initials: Y
authors.lastname: Zopf
authors.forename: P
authors.initials: P
authors.lastname: Konturek
authors.forename: A
authors.initials: A
authors.lastname: Nuernberger
authors.forename: J
authors.initials: J
authors.lastname: Maiss
authors.forename: J
authors.initials: J
authors.lastname: Zenk
authors.forename: H
authors.initials: H
authors.lastname: Iro
authors.forename: E G
authors.initials: EG
authors.lastname: Hahn
authors.forename: D
authors.initials: D
authors.lastname: Schwab
mesh_terms: D000368:Aged; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*