Hull M, Beane A, Bowen J, Settle C
Division of Medicine, St James's University Hospital, Leeds, UK.
Aliment Pharmacol Ther. 2001 Dec;15(12):1883-8. doi: 10.1046/j.1365-2036.2001.01124.x.
Antibiotic prophylaxis for percutaneous endoscopic gastrostomy insertion remains controversial. The bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion has been poorly studied, leading to uncertainty regarding the optimum choice of antibiotic for prophylaxis.
To investigate the bacteriology of peristomal infection following percutaneous endoscopic gastrostomy insertion and to determine the contribution of methicillin-resistant Staphylococcus aureus.
Nasal and pharyngeal swabs were taken from a consecutive series of patients prior to percutaneous endoscopic gastrostomy insertion over a 6-month period. Bacterial colonization and infection at the peristomal site were prospectively evaluated at days 2/3 and 7 post-insertion.
Thirty-one patients underwent percutaneous endoscopic gastrostomy insertion (mean age, 68 years; cerebrovascular disease, 52%). Naso-pharyngeal colonization by methicillin-resistant Staphylococcus aureus (35%) invariably led to peristomal colonization following percutaneous endoscopic gastrostomy insertion. Peristomal infection occurred in eight (26%) cases (seven (88%) methicillin-resistant Staphylococcus aureus- positive). Peristomal infection was significantly more likely to occur in patients with naso-pharyngeal methicillin-resistant Staphylococcus aureus colonization (odds ratio, 10.8; 95% confidence interval, 1.6-70.9).
Naso-pharyngeal methicillin-resistant Staphylococcus aureus colonization invariably predicts peristomal methicillin-resistant Staphylococcus aureus colonization following percutaneous endoscopic gastrostomy insertion, and is associated with an increased peristomal infection rate. Currently recommended antibiotic prophylaxis regimens may be inappropriate in institutions with significant methicillin-resistant Staphylococcus aureus colonization rates.
经皮内镜下胃造口术插入时的抗生素预防仍存在争议。经皮内镜下胃造口术插入后造口周围感染的细菌学研究较少，导致预防用抗生素的最佳选择存在不确定性。
研究经皮内镜下胃造口术插入后造口周围感染的细菌学，并确定耐甲氧西林金黄色葡萄球菌的作用。
在6个月期间，对连续一系列经皮内镜下胃造口术插入术前的患者采集鼻和咽拭子。前瞻性评估插入后第2/3天和第7天造口周围部位的细菌定植和感染情况。
31例患者接受了经皮内镜下胃造口术插入（平均年龄68岁；脑血管疾病患者占52%）。耐甲氧西林金黄色葡萄球菌的鼻咽定植（35%）在经皮内镜下胃造口术插入后总是导致造口周围定植。8例（26%）发生造口周围感染（7例（88%）耐甲氧西林金黄色葡萄球菌阳性）。鼻咽部耐甲氧西林金黄色葡萄球菌定植的患者发生造口周围感染的可能性显著更高（比值比，10.8；95%置信区间，1.6 - 70.9）。
鼻咽部耐甲氧西林金黄色葡萄球菌定植总是预示经皮内镜下胃造口术插入后造口周围耐甲氧西林金黄色葡萄球菌定植，并与造口周围感染率增加相关。在耐甲氧西林金黄色葡萄球菌定植率较高的机构中，目前推荐的抗生素预防方案可能不合适。
