title: Airway infection predisposes to peristomal infection after percutaneous endoscopic gastrostomy with high concordance between sputum and wound isolates.
abstract: BACKGROUND
  Peristomal infection is common after percutaneous endoscopic gastrostomy. This study aims to evaluate the correlation between airway and peristomal infected pathogens.
  
  
  METHODS
  Before the procedure, sputum cultures were prospectively performed for the patients with airway symptoms. All the patients received prophylactic antibiotics. Once peristomal infection occurred, the wound cultures were obtained to analyze the antibiotic susceptibilities of the pathogens. The paired isolates, with concordance between sputum and wound cultures, were validated for their clone identity using pulsed-field gel electrophoresis.
  
  
  RESULTS
  One hundred twelve patients were enrolled, and 30 patients had peristomal infection. The 31 patients with airway pathogens had a 10-fold higher risk of peristomal infection than the other 81 without airway pathogens (95% CI, 3.85-26.4, p < 0.001). Among patients collected with paired isolates from wound and sputum, 85% had concordant microorganism species. In the paired concordant isolates, 94% had indistinguishable antibiogram, and nearly 90% were clonally identical in pulsed-field gel electrophoresis.
  
  
  CONCLUSIONS
  Patients with airway infection have an increased risk of peristomal infection after percutaneous endoscopic gastrostomy. Concerning the high concordance between infected wound and sputum isolates of such patients, the selection of appropriate prophylactic antibiotics could be individual to cover the microorganisms isolated from sputum.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan.
authors.forename: Chiao-Hsiung
authors.initials: CH
authors.lastname: Chuang
authors.forename: Kuei-Hsiang
authors.initials: KH
authors.lastname: Hung
authors.forename: Jen-Ru
authors.initials: JR
authors.lastname: Chen
authors.forename: Chiung-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Ai-Wen
authors.initials: AW
authors.lastname: Kao
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Chang
authors.forename: Jiunn-Jong
authors.initials: JJ
authors.lastname: Wu
authors.forename: Bor-Shyang
authors.initials: BS
authors.lastname: Sheu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D001419:Bacteria / Q000145:classification; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000150:complications* / Q000382:microbiology; D013183:Sputum / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology* / Q000517:prevention & control