Tailored Antibiotics Prophylaxis for Percutaneous Endoscopic Gastrostomy (PEG)
Recruitment status was Recruiting
Tailored antibiotic prophylaxis according to the individual throat swab culture could reduce the peristomal infection rate
The Patients Who Receive Percutaneous Endoscopic Gastrostomy
Peristomal Wound Infection After the Operation of PEG
Prophylactic Antibiotics Before PEG
Drug: Tailored antibiotic
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Prevention
|Official Title:||Impact of Oropharyngeal Microorganism Colonization on the Peristomal Infection After Percutaneous Endoscopic Gastrostomy and the Effect of Tailored Antibiotics Prophylaxis|
- Peristomal wound infection [ Time Frame: Two weeks after operation of PEG ] [ Designated as safety issue: Yes ]
|Study Start Date:||July 2010|
|Estimated Study Completion Date:||August 2011|
|Estimated Primary Completion Date:||July 2011 (Final data collection date for primary outcome measure)|
Active Comparator: Cefuroxime group
Use the cefuroxime as prophylactic antiobiotics, according to the clinical guideline.
Use the cefuroxime as prophylaxis.
Experimental: Tailored antibiotics group
Tailored antibiotic is selected according to the patient's oropharyngeal microorganisms.
Drug: Tailored antibiotic
Select the prophylactic antibiotics according to the patients oropharyngeal microorganism.
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Antibiotic prophylaxis has been shown to be effective to reduce peristomal infection.[9-11] The penicillin-or cephalosporin-based antibiotic prophylaxis are usually used with similar efficacy. EuropeanSociety of Gastrointestinal Endoscopy (ESGE) guideline recommend that a single dose of intravenous cephalosporin orpenicillin as preparation before PEG. The updated practice guidelines of American Society for Gastrointestinal Endoscopy (ASGE) and British Society of Gastroenterology (BSG) also recommend cefazolin or cefuroxime as prophylactic antibiotics.[18-19]
Is the 1st or 2nd generation cephalosporin is adequate as prophylactic antibiotics for percutaneous endoscopic gastrostomy (PEG)?
- The leading two common pathogen to cause peristomal infection of PEG are P. aeuroginosa and methecillin-resistanced S. aurous. (Figure 1) These two common pathogen can't be covered by the prophylactic antibiotics which suggested by guideline.
- The patient with airway infection before PEG had higher peristomal infection rate, comparing with those without airway infection. Moreover, adequate antibiotics prophylaxis could significant improve the infection rate. (Table 1)
Tailored antibiotic prophylaxis according to the individual throat swab culture could reduce the peristomal infection rate.
- If individual tailored antibiotic prophylaxis according to throat swab could reduce the peristomal infection rate?
- If the phenotype and genotype analysis were compatible between infected wound isolates and throat swab/sputum isolates?
- If throat swab culture is better than sputum culture to predict peristomal infected microorganism?
- Is the infection is also linked to the oropharyngeal isolates if the patients get peristomal infection more than one week after PEG?
- Individual tailored antibiotic prophylaxis according to the throat swab culture could reduce the peristomal infection rate of PEG and short the days of hospitalization.
- Most phenotype and genotype are compatible between peristomal isolates and throat swab/sputum isolates. It indicates that most pathogens are carried from throat into the peristomal to cause the infection. The microorganism isolated from throat swab could predict the pathogen of PEG peristomal infection.
- The throat swab culture may be better than sputum culture to predict the peristomal infected pathogen because some unconscious patients is difficult to collect sputum.
- Peristomal infection more than one week after PEG may be not associated to throat pathogen. It may be related to the contamination during wound care.
This proposal result could be applied to clinical care of percutaneous endoscopic gastrostomy. The individual chose of prophylactic antibiotics could improve the peristomal infection rate. Currently, 1st or 2nd cephalosporin was usually recommended as prophylaxis before PEG. However, for the patient with ORSA culture from nasal cavity, vancomycin was suggested as prophylaxis because some studies support the benefit on infection prevention. If the results are positive, it may change the clinical guideline on antibiotics prophylaxis before PEG.
|Contact: chiao-hsiung chuang, M.D.||88662353535 ext firstname.lastname@example.org|
|National Cheng Kung University Hospital||Recruiting|
|Tainan, Taiwan, 704|
|Contact: chiaohsiung chuang, M.D. 88662353535 ext 2679 email@example.com|
|Principal Investigator: chiao-hsiung chuang, M.D.|
|Study Director:||chiao-hsiung chuang, M.D.||National Cheng-Kung University Hospital|