Effects of gastric acidity on peristomal infection after percutaneous endoscopic gastrostomy placement

• Published in: The Journal of hospital infection 2010-09, Vol.76 (1), p.42-45
• Main Authors: Ono, H, Ito, S, Yamazaki, Y, Otaki, Y, Otaki, H
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Bacteria - classification; Bacteria - isolation & purification; Bacterial diseases; Bacterial Infections - epidemiology; Bacterial Infections - microbiology; Biological and medical sciences; Carrier State - microbiology; Diseases of the digestive system; Female; Gastric acidity; Gastric Juice - chemistry; Gastrostomy - adverse effects; Human bacterial diseases; Humans; Incidence; Infectious Disease; Infectious diseases; Male; Medical sciences; Meticillin-resistant Staphylococcus aureus; Middle Aged; Oropharynx - microbiology; Percutaneous endoscopic gastrostomy; Peristomal infection; pH monitoring; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Staphylococcal infections, streptococcal infections, pneumococcal infections; Stomach - chemistry; Wound Infection - epidemiology; Wound Infection - microbiology
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2010.04.011

Summary Peristomal infection is a common complication following percutaneous endoscopic gastrostomy (PEG) placement. This study investigated the effect of gastric acidity on peristomal infection, including type of bacteria and the relationship between bacteria cultured from the oropharynx and PEG tube site. Sixty-seven patients with dysphagia underwent PEG placement at Otaki Hospital between 1998 and 2001. Gastric acidity was evaluated by 24 h pH monitoring. Patients were observed for peristomal infection for two weeks after PEG placement, with specimens collected from the oropharynx and PEG tube site. Twenty-one (31.3%) of the patients who had undergone PEG insertion developed peristomal infections. Of 52 patients who were not colonised with meticillin-resistant Staphylococcus aureus (MRSA) in the oropharynx, 11 cases (21.2%) developed peristomal infection. The median gastric pH of infected patients (11 cases) was 5.05 ± 2.55 (mean ± SD) and in patients without infection (41 cases) it was 3.06 ± 1.83 ( P = 0.019). Peristomal infection developed in 66.7% (10/15) of patients carrying MRSA compared with only 21.2% (11/52) of patients who were not colonised by MRSA ( P < 0.001). The incidence of peristomal infection was affected by gastric acidity and the presence of MRSA in the oropharynx.