Lipp Allyson, Lusardi Gail
Faculty of Health, Sport and Science, University of Glamorgan, Pontypridd, UK.
J Clin Nurs. 2009 Apr;18(7):938-48. doi: 10.1111/j.1365-2702.2008.02585.x. Epub 2008 Nov 29.
To establish whether prophylactic systemic antimicrobials reduce the risk of peristomal infection in placement of percutaneous endoscopic gastrostomies.
Percutaneous endoscopic gastrostomies, placed surgically through the anterior abdominal wall, maintain nutrition in the short or long term. Those undergoing percutaneous endoscopic gastrostomy placement are often vulnerable to infection. The increasing incidence of methicillin-resistant Staphylococcus aureus contributes an additional risk to the debate surrounding antibiotic prophylaxis. The aim of antimicrobial prophylaxis is to establish a bactericidal concentration of an antimicrobial drug in the patient, during placement.
Systematic review.
We searched the Cochrane Wounds Group Specialised Register (July 2006); The Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2); handsearched wound care journals, relevant conference proceedings and bibliographies of publications identified, and contacted manufacturers and distributors of percutaneous endoscopic gastrostomy products. Randomised controlled trials were selected evaluating the use of prophylactic antimicrobials for percutaneous endoscopic gastrostomy placement, with no restrictions for language, date or publication status. Both authors performed data extraction and assessment of study quality. Meta-analysis was performed where appropriate.
Ten eligible randomised controlled trials were identified evaluating prophylactic antimicrobials in 1100 patients. All trials reported peristomal infection as an outcome and a pooled analysis resulted in a statistically significant reduction in the incidence of peristomal infection with prophylactic antibiotics (pooled OR 0.31, 95% CI 0.22-0.44). The relative reduction in risk of infection for those given antibiotics was 19% with the need to treat 5.8 patients to prevent one infection - NNT.
Administration of systemic prophylactic antibiotics for percutaneous endoscopic gastrostomy placement reduces peristomal infection.
The nurse's role in endoscopy is expanding rapidly and demands that practice is based on the best available evidence. This systematic review seeks to make a contribution to best practice in percutaneous endoscopic gastrostomy placement.
确定预防性全身使用抗菌药物是否能降低经皮内镜下胃造口术（PEG）置管时造口周围感染的风险。
经皮内镜下胃造口术通过腹壁前部手术置入，可在短期或长期维持营养。接受经皮内镜下胃造口术置管的患者常易发生感染。耐甲氧西林金黄色葡萄球菌发病率的增加为围绕抗生素预防的争论增添了额外风险。抗菌药物预防的目的是在置管期间在患者体内建立抗菌药物的杀菌浓度。
系统评价。
我们检索了Cochrane伤口小组专业注册库（2006年7月）；Cochrane对照试验中央注册库（Cochrane图书馆2006年第2期）；手工检索伤口护理期刊、相关会议论文集以及已识别出版物的参考文献，并联系经皮内镜下胃造口术产品的制造商和经销商。选择评估预防性抗菌药物用于经皮内镜下胃造口术置管的随机对照试验，对语言、日期或发表状态无限制。两位作者进行数据提取和研究质量评估。在适当情况下进行荟萃分析。
确定了10项符合条件的随机对照试验，评估了1100例患者使用预防性抗菌药物的情况。所有试验均将造口周围感染作为一项结局指标，汇总分析结果显示，预防性使用抗生素可使造口周围感染的发生率在统计学上显著降低（汇总比值比0.31，95%可信区间0.22 - 0.44）。接受抗生素治疗的患者感染风险相对降低了19%，预防1例感染需要治疗5.8例患者 - 需治疗人数。
经皮内镜下胃造口术置管时使用全身预防性抗生素可降低造口周围感染的发生率。
护士在内镜检查中的作用正在迅速扩大，要求实践基于最佳可得证据。本系统评价旨在为经皮内镜下胃造口术置管的最佳实践做出贡献。
