Fungal Infection Management at Gastrostomy or Tube Sites

Assessment and Identification

The Clinical Nutrition guideline recommends inspecting the site for signs of fungal infection including loss of skin integrity, erythema, purulent and/or malodorous exudate, fever, and pain 1
Swab the area for both bacterial and fungal culture to confirm infection type before treatment, as recommended by Clinical Nutrition 1
Check for risk factors that predispose to fungal infections including diabetes, obesity, poor nutritional status, chronic corticosteroid therapy, or other immunosuppressive therapy, according to Clinical Nutrition 1
Assess for hyper-hydrated or inflamed skin due to leakage, which can promote growth of microorganisms, as noted by Clinical Nutrition 1

Gather necessary supplies: antimicrobial agent (ointment or dressing), clean gloves, sterile water, cleaning solution, and disposal bag, as recommended by Clinical Nutrition 1, 2
Ensure the external bolster is not too tight, causing excessive pressure between internal and external bolster which can contribute to infection, according to Clinical Nutrition 1
For established stoma sites, clean twice weekly with soap and water of drinking quality, as suggested by Clinical Nutrition 2
For newer sites (less than one week old), use aseptic technique for wound care, as recommended by Clinical Nutrition 1

Clean the affected area thoroughly with soap and water and dry completely, as recommended by Clinical Nutrition 2
Apply a topical antifungal agent to the entry site of the tube and surrounding tissue, according to Clinical Nutrition 1
For sustained release, use antimicrobial dressings that get their activity from silver, iodine or polyhexamethylene biguanide, available in different forms (foams, hydrocolloids or alginates), as suggested by Clinical Nutrition 1
Be aware of potential allergies to product components and note that silver dressings cannot be used during MRI procedures, as noted by Clinical Nutrition 1
For silicone tubes with fungal infection, tube removal and/or replacement may be necessary, according to Clinical Nutrition 1

If using a foam dressing rather than gauze, this can reduce local skin irritation as foam lifts drainage away from the skin, whereas gauze can contribute to more skin maceration, as recommended by Clinical Nutrition 2
Apply a barrier film or cream to protect surrounding skin if the area is exuding, as suggested by Clinical Nutrition 2
For balloon-type tubes, check the water volume weekly to prevent spontaneous balloon deflation due to water leakage, according to Clinical Nutrition 3
For persistent fungal infections, especially with silicone tubes, removal and replacement of the gastrostomy tube may be necessary, as recommended by Clinical Nutrition 1

Monitor the site daily for improvement or worsening of infection, as recommended by Clinical Nutrition 1
If the fungal infection cannot be resolved with topical antimicrobial treatment combined with systemic antifungal agents, tube removal should be considered, according to Clinical Nutrition 1
For fungal infections that persist despite appropriate treatment, consider stoma tract disruption, peristomal infection, or skin excoriation as potential complications requiring tube replacement, as noted by Clinical Nutrition 1
Maintain good hygiene practices after treatment to prevent recurrence, as recommended by Clinical Nutrition 1

Avoid using topical antibiotics for fungal infections as they are ineffective and may promote resistance, according to Clinical Nutrition 1
Do not use saline in balloon-type tubes; use sterile water instead, as recommended by Clinical Nutrition 3
Ensure dressings are changed when they become damp, loose, soiled, or non-adherent, as suggested by the American Journal of Kidney Diseases 4
Be vigilant about fungal infections in patients with diabetes, obesity, poor nutritional status and those on chronic corticosteroid therapy or other immunosuppressive therapy, according to Clinical Nutrition 1