G-Tube Replacement and Staphylococcus Bacteremia Risk

Understanding the Risk

Stoma site infections occur in approximately 15% of cases after transoral gastrostomy placement, with an overall infection rate of 4.8% in community hospital settings 1
Most G-tube infections remain localized and do not progress to bacteremia when treated appropriately 1

Patients with diabetes mellitus are at elevated risk for bacteremia during G-tube replacement 2, 3, 4
Patients with obesity are at elevated risk for bacteremia during G-tube replacement 2, 3, 4
Patients with poor nutritional status are at elevated risk for bacteremia during G-tube replacement 2, 3, 4
Patients with chronic corticosteroid therapy or other immunosuppressive treatment are at elevated risk for bacteremia during G-tube replacement 2, 3, 4
Excessive tension between internal and external bolsters causing tissue necrosis increases the risk of bacteremia 1

The American College of Gastroenterology recommends examining the stoma site for signs of active infection before replacement 1, 5
The American College of Gastroenterology recommends swabbing the area for bacterial and fungal cultures before any manipulation if infection is suspected 1, 5
Ensuring the external bolster has approximately 1 cm of play can reduce tissue pressure and infection risk 1, 5
Prophylactic antibiotics with first-generation cephalosporin or similar agent covering cutaneous organisms is recommended for percutaneous procedures 6
Treating active stoma infection with systemic broad-spectrum antibiotics before elective replacement is recommended 2, 3, 1

Fever with systemic signs requires immediate action and potential initiation of intravenous broad-spectrum antibiotics 1
Persistent or worsening local infection despite topical treatment requires immediate action and potential initiation of intravenous broad-spectrum antibiotics 1, 5
Signs of peritonitis require immediate action and potential initiation of intravenous broad-spectrum antibiotics 7, 5
Obtaining blood cultures before starting antibiotics is crucial in suspected bacteremia cases 1
Initiating intravenous broad-spectrum antibiotics covering Staphylococcus aureus, Pseudomonas, and gram-negative organisms is recommended in suspected bacteremia cases 1

Topical antibiotics should not be used as they promote resistance; instead, use antimicrobial ointments or sustained-release dressings with silver, iodine, or polyhexamethylene biguanide 2, 3, 1
Delaying systemic antibiotics in patients with signs of bacteremia while waiting for culture results is not recommended 1
Ignoring excessive bolster tension can create tissue necrosis and a direct portal for bacterial invasion into the bloodstream 1