Treatment of PEG Tube Site Infection

Diagnosis and Assessment

Site infection is a common complication after transoral gastrostomy placement, occurring in approximately 15% of cases 1
Risk factors include diabetes, obesity, poor nutritional status, chronic corticosteroid therapy, and other immunosuppressive therapy 2, 3
Signs and symptoms of infection include loss of skin integrity, erythema, purulent and/or malodorous exudate, fever, and pain 2, 3
Distinguish between true infection and minor reddening (<5mm) around the stoma, which is often caused by movement and not necessarily infection 1
Obtain swabs for both bacterial and fungal cultures before initiating antimicrobial therapy 2, 3

Clean the affected skin at least once daily using an antimicrobial cleanser 4, 2
Apply a topical antimicrobial agent to the entry site and surrounding tissue 4, 2, 3
If the infection does not resolve with topical treatment, add systemic broad-spectrum antibiotics 4, 2, 3
Tailor antibiotic therapy based on culture results 2, 3

Ensure proper tension between internal and external bolsters to avoid excessive pressure 2, 3
Prevent leakage which can lead to hyper-hydrated or inflamed skin and promote microbial growth 2, 3
For skin protection, apply barrier films, pastes, or creams containing zinc oxide 5
Use foam dressings rather than gauze to reduce skin maceration 5

For excessive granulation tissue, apply barrier film or cream to protect surrounding skin and consider topical antimicrobial agents, foam or silver dressings, silver nitrate cauterization, or topical corticosteroids for 7-10 days 4, 2

The use of a Y-compress can help avoid the formation of a moist cavity under the external fixation plate, reducing the risk of infection 6, 7

HIV-positive patients with advanced immunodeficiency are at a higher risk of local infection at the PEG exit site, although severe complications are not more frequent than in control populations 8