title: Antibiotic prophylaxis does not reduce the infection rate following percutaneous endoscopic gastrostomy in infants and children.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) is the standard for placing gastrostomy in children needing long-term enteral nutrition, with major and minor complications reported in up to 19% and 47.7% of children, respectively. We reviewed our experience with PEG, concentrating on the efficacy of antibiotic prophylaxis in reducing infectious complications.
  
  
  METHODS
  We performed a retrospective, single-centre study that comprised all children up to 18 years of age who underwent a first PEG procedure in the VU University Medical Centre, Amsterdam, from 2008 to 2012. All complications up to one month after PEG were recorded. Infection rates with and without antibiotic prophylaxis could be compared as a new protocol requiring the preprocedure administration of cefazolin was not followed consistently.
  
  
  RESULTS
  We enrolled 129 patients (78 male) with a mean age of 4.9 ± 4.8 years and median age of 2.9 years. Major complications were seen in seven patients (5.4%) and minor complications in 23 patients (17.8%). Antibiotic prophylaxis was administered to 99 of 129 children (76.7%). Infections occurred in 15 of 129 patients (11.6%); 14 of 99 with and 1 of 30 without prophylaxis developed infections (p = 0.106). Peristomal infections were the most frequent complication (10.1%).
  
  
  CONCLUSIONS
  Percutaneous endoscopic gastrostomy was a safe procedure and antibiotic prophylaxis did not seem to decrease infectious complications.
authors.affiliation: Department of Paediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Anne L
authors.identifier: http://orcid.org/0000-0003-0820-2013
authors.initials: AL
authors.lastname: van Els
authors.affiliation: Princess Amalia Children's Centre, Isala Hospital, Zwolle, The Netherlands.
authors.forename: J Joris
authors.initials: JJ
authors.lastname: van Driel
authors.affiliation: Department of Paediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Cm Frank
authors.initials: CF
authors.lastname: Kneepkens
authors.affiliation: Department of Paediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Tim G J
authors.initials: TG
authors.lastname: de Meij
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin
keywords: Antibiotic prophylaxis; Complications; Enteral nutrition; Percutaneous endoscopic gastrostomy; Peristomal infection