A Better Method for Preventing Infection of Percutaneous Endoscopic Gastrostomy

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• 作者：Chao-Hung Kuo (1) (2) (3) (4)
  Huang-Ming Hu (1)
  Pei-Yun Tsai (1) (5)
  Chen-Ju Liu (1) (5)
  Fang-Jung Yu (2)
  Ko Chang (1) (6)
  Yong-Sang Pan (2) (4)
  Angela Chen (7) (8)
  Chang-Ming Jan (2) (4)
  Wen-Ming Wang (2) (4)
  Deng-Chyang Wu (2) (4) (7) (8) (9)
  
• 关键词：Percutaneous endoscopic gastrostomy
• 刊名：Journal of Gastrointestinal Surgery
• 出版年：2008
• 出版时间：February 2008
• 年：2008
• 卷：12
• 期：2
• 页码：358-363
• 全文大小：143KB
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• 作者单位：Chao-Hung Kuo (1) (2) (3) (4)
  Huang-Ming Hu (1)
  Pei-Yun Tsai (1) (5)
  Chen-Ju Liu (1) (5)
  Fang-Jung Yu (2)
  Ko Chang (1) (6)
  Yong-Sang Pan (2) (4)
  Angela Chen (7) (8)
  Chang-Ming Jan (2) (4)
  Wen-Ming Wang (2) (4)
  Deng-Chyang Wu (2) (4) (7) (8) (9)
  
  1. Division of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
  2. Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  3. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  4. Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  5. Department of Nursing, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
  6. Division of Infection, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  7. Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
  8. National Sun Yat-Sen Univeristy-Kaoshiung Medical University Joint Center, Kaohsiung, Taiwan
  9. Kaohsiung Medical University Hospital, No.100, Zih-You 1st Road, Kaohsiung, 807, Taiwan
  

文摘

Background Percutaneous endoscopic gastrostomy (PEG) has been widely used to maintain enteral nutrition in dysphagic patients. Local and occasional life-threatening systemic infections are still the most common complications, and the major infection source may be nosocomial flora. The effect of antibiotic prophylaxis on reducing peristomal infection is popularly accepted. However, it is accompanied with a possible risk of increasing antibiotic resistance. Aim This study attempted to determine whether 14-day discharge before PEG could reduce the rate of peristomal infection. Materials and Methods Fifty patients who had received PEG in our hospital were included in this study and followed for at least 6?months (except for those patients who died during this period). Patients were separated into two groups randomly. Twenty-five patients received PEG during in-hospitalization (group A). The other 25 patients received PEG until discharge at least for 14?days (group B). The most frequent indication for PEG insertion was the neurological condition. Risk factors for peristomal infection were analyzed statistically using logistic regression and expressed by odds ratios. Every possible factor was analyzed by chi-square test or Student’s t test. Result Our data showed that group A had a higher peristomal infection rate than group B (32 vs 8%) (p-lt;-.05).Group A also showed more need of antibiotics. The risk factors related to peristomal infection were group A and lower albumin. The total rate of 30-day mortality was 4%. Discussion When compared with previous data, our study showed a similar infection rate in group A, a lower infection rate in group B, and a lower 30-day mortality rate. This meant that one period of discharge could reduce the peristomal infections caused by colonized bacteria. It also decreased the need of using antibiotics and might avoid the possible adverse consequence of promoting bacterial resistance, which is an alarming and growing problem in hospital practice. Conclusion We suggest that a 14-day grace period after discharge, before PEG insertion, may decrease peristomal infection rate, length of hospital stay after PEG, and the need for antibiotics. This is suitable for moral and ethical considerations.