Management of Stoma Site Infections
Initial Assessment and Diagnosis
- The American Gastroenterological Association recommends looking for signs and symptoms of infection including loss of skin integrity, erythema, purulent and/or malodorous exudate, fever, and pain in patients with stoma site infections 2, 3
- Swabbing the area for both bacterial and fungal culture is recommended to guide targeted therapy in patients with stoma site infections 2, 3
- Ensuring the external bolster is not too tight is crucial, as excessive pressure between internal and external bolsters is associated with higher infection rates in patients with stomas 4, 5
Treatment Algorithm
- The American College of Gastroenterology recommends applying a topical antimicrobial agent to the entry site of the tube and surrounding tissue as first-line treatment for stoma site infections 1, 2
- Systemic broad-spectrum antibiotics should be added if the infection doesn't resolve with topical treatment, with options including oral broad-spectrum antibiotics for 5-7 days for minor infections 4, 5
- For more severe infections with systemic signs, intravenous broad-spectrum antibiotics coupled with local wound care are recommended 4, 5
Additional Wound Care Measures
- Cleaning the stoma site at least once daily using an antimicrobial cleanser is recommended for patients with stoma site infections 1, 6
- Applying stoma adhesive powder or zinc oxide can help prevent local skin irritation in patients with stomas 4, 5
- Using foam dressings rather than gauze can reduce local skin irritation by lifting drainage away from the skin 4, 5
Special Considerations
- High-risk patients for stoma site infections include those with diabetes, obesity, poor nutritional status, and those on chronic corticosteroid or other immunosuppressive therapy 4, 2, 3
- Ensuring proper positioning of the external bolster with approximately 1 cm of play between the skin and external bolster can help maintain proper tension and decrease the likelihood of complications 4, 5