Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy

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Authors
Category Systematic review
JournalCochrane Database of Systematic Reviews
Year 2006
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a surgical procedure performed to maintain nutrition in the short- or long-term. During the procedure, a feeding tube that delivers either a liquid diet, or medication, via a clean or sterile delivery system, is placed surgically through the anterior abdominal wall. Those undergoing PEG tube placement are often vulnerable to infection because of age, compromised nutritional intake, immunosuppression, or underlying disease processes such as malignancy and diabetes mellitus. The increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) contributes both an additional risk to the placement procedure, and to the debate surrounding antibiotic prophylaxis for PEG tube placement. The aim of surgical antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient's serum and tissues, via a brief course of an appropriate agent, by the time of PEG tube placement in order to prevent any peristomal infections that might result from the procedure. OBJECTIVES: To establish whether prophylactic use of systemic antimicrobials reduces the risk of peristomal infection in people undergoing placement of percutaneous endoscopic gastrostomy tubes. SEARCH METHODS: For this second update, we searched the Cochrane Wounds Group Specialised Register (searched 16 February 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1); Ovid MEDLINE (1950 to February Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations February 15, 2011); Ovid EMBASE (1980 to 2011 Week 06); and EBSCO CINAHL (1982 to 11 February 2011). SELECTION CRITERIA: Randomised controlled trials (RCTs) evaluating the use of prophylactic antimicrobials during PEG tube placement, with no restrictions regarding language of publication, date of publication, or publication status. DATA COLLECTION AND ANALYSIS: Both authors extracted data and assessed study quality. Meta-analyses were performed where appropriate. MAIN RESULTS: One new trial was identified and included in this update, bringing the total to 12 eligible RCTs, with a total of 1271 patients. All trials reported peristomal infection as an outcome, and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (1271 patients pooled: OR 0.36, 95% CI 0.26 to 0.50). AUTHORS' CONCLUSIONS: Administration of systemic prophylactic antibiotics for PEG tube placement reduces peristomal infection.
Epistemonikos ID: de46bf46671b43d7da94309e6955bd7ee009a659
First added on: Nov 08, 2012