A team from Leeds, England, investigated the bacteriology of peristomal infection following percutaneous endoscopic gastrostomy (PEG) insertion. They also determined the contribution of methicillin-resistant Staphylococcus aureus.
Nasal and pharyngeal swabs were taken from a consecutive series of patients prior to PEG insertion, over a 6-month period.
Bacterial colonization and infection at the peristomal site were prospectively evaluated at days 2, 3, and 7 post-insertion.
A total of 31 patients (mean age, 68 years; cerebrovascular disease, 52%) underwent PEG insertion.
Naso-pharyngeal colonization by methicillin-resistant S. aureus was found to occur in 35% of the patients. This invariably led to peristomal colonization following PEG insertion.
|88% of peristomal infection cases were methicillin-resistant S. aureus-positive.
| Alimentary Pharmacology & Therapeutics |
Peristomal infection occurred in 8 (26%) cases, of which 7 (88%) were methicillin-resistant S. aureus-positive.
The researchers found that peristomal infection was significantly more likely to occur in patients with naso-pharyngeal methicillin-resistant S. aureus colonization (odds ratio, 11).
Dr M. Hull, of the Division of Medicine at St. James's University Hospital, Leeds, said on behalf of colleagues, "Naso-pharyngeal methicillin-resistant S. aureus colonization invariably predicts peristomal colonization by this bacterium following PEG insertion, and is associated with an increased peristomal infection rate."
"Currently recommended antibiotic prophylaxis regimens may be inappropriate in institutions with significant methicillin-resistant S. aureus colonization rates," it was concluded.