经皮内镜下胃造口管置入术后的局部感染：一项评估危险因素的前瞻性研究
Local infection after placement of percutaneous endoscopic gastrostomy tubes: a prospective study evaluating risk factors.
作者信息
Zopf Y, Konturek P, Nuernberger A, Maiss J, Zenk J, Iro H, Hahn E G, Schwab D
机构信息
Department of Medicine, Friedrich-Alexander-University, Erlangen, Germany.
出版信息
Can J Gastroenterol. 2008 Dec;22(12):987-91. doi: 10.1155/2008/530109.
BACKGROUND
Due to its high efficacy and technical simplicity, percutaneous endoscopic gastrostomy (PEG) has gained wide-spread use. Local infection, occurring in approximately 2% to 39% of procedures, is the most common complication in the short term. Risk factors for local infection are largely unknown and therefore--apart from calculated antibiotic prophylaxis--preventive strategies have yet to be determined.
OBJECTIVE
To assess the potential patient- and procedure-related risk factors for peristomal infection following PEG tube placement.
METHODS
Potential patient-related (eg, age, sex, diseases, body mass index, concomitant antibiotic therapy) and procedure-related (endoscopist experience, institutional factors, findings on endoscopy) risk factors and their coincidence with local infection, defined as a positive peristomal infection three days after PEG tube placement, were evaluated at two institutions. A standardized antibiotic prophylaxis was not performed. The peristomal infection score was also evaluated in 390 patients.
RESULTS
Using a multivariate binary regression analysis, four risk factors were established as relevant for local infection after PEG: clinical institution (OR 6.69; P = 0.0001), size of PEG tubes (15 Fr versus 9 Fr; OR 2.12; P = 0.05), experience of the endoscopist (more than 100 investigations versus less than 100 investigations; OR 0.54; P = 0.05) and the existence of a malignant underlying disease (OR 2.28; P = 0.019).
CONCLUSIONS
Similar to other endoscopic interventions, local infection as a complication of PEG tube placement depends on the experience of the endoscopist. Institutional factors also play a significant role. Additional risk factors include PEG tube size and underlying diseases. These findings indicate that the local infection after PEG tube placement may be influenced by both endoscopy-associated factors and by the underlying disease status of the patient.
背景
经皮内镜下胃造口术（PEG）因其高效性和技术简便性而得到广泛应用。局部感染是短期内最常见的并发症，发生率约为2%至39%。局部感染的危险因素大多未知，因此，除了计算抗生素预防剂量外，尚未确定预防策略。
目的
评估PEG管置入术后造口周围感染的潜在患者及手术相关危险因素。
方法
在两家机构评估潜在的患者相关（如年龄、性别、疾病、体重指数、联合抗生素治疗）和手术相关（内镜医师经验、机构因素、内镜检查结果）危险因素及其与局部感染的相关性，局部感染定义为PEG管置入术后三天造口周围感染呈阳性。未进行标准化的抗生素预防。还对390例患者的造口周围感染评分进行了评估。
结果
采用多变量二元回归分析，确定了PEG术后局部感染的四个相关危险因素：临床机构（比值比6.69；P = 0.0001）、PEG管尺寸（15 Fr对9 Fr；比值比2.12；P = 0.05）、内镜医师经验（超过100次检查对少于100次检查；比值比0.54；P = 0.05）以及潜在恶性疾病的存在（比值比2.28；P = 0.019）。
结论
与其他内镜干预措施类似，PEG管置入术的并发症局部感染取决于内镜医师的经验。机构因素也起着重要作用。其他危险因素包括PEG管尺寸和基础疾病。这些发现表明，PEG管置入术后的局部感染可能受内镜相关因素和患者基础疾病状态的影响。
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