Targeted Antimicrobial Agent Prophylaxis Fails to Reduce Peristomal Infections by Multi-Drug-Resistant Bacteria Following Percutaneous Endoscopic Gastrostomy: A Prospective Cohort Study

Abstract

Background:

Peristomal infection (PI) is the most frequent complication following percutaneous gastrostomy, and the increase of multi-drug-resistant (MDR) bacteria poses a therapeutic challenge. We evaluated whether targeted antimicrobial agent prophylaxis (TAP), on the basis of pre-procedure rectal screening, reduces the incidence of MDR PIs compared with standard prophylaxis.

Methods:

We conducted a single-center, single-arm, open-label trial, comparing a prospective cohort (July 2021–July 2022) receiving TAP based on MDR screening results with a retrospective cohort (June 2020–June 2021) that received standard prophylaxis. A total of 118 patients were included, 60 in the intervention group and 58 in the historical cohort. TAP patients underwent a pre-procedure screening tactic, using nasal, axillary, inguinal, pharyngo-tonsillar, and rectal swabs. Patients with positive cultures received prophylaxis with an antibiotic agent active against the isolated bacteria, along with coverage for methicillin-sensitive Staphylococcus aureus. Patients with negative cultures received standard prophylaxis with amoxicillin–clavulanate. Both regimens were administered as a single dose one hour before the procedure.

Results:

MDR colonization was detected in 36.4% of screened patients. The 30-day PI incidence was comparable in both cohorts [20.7% (12/58) in the historical cohort vs. 16.7% (10/60) in the intervention group; p = 0.64]. Among TAP patients who developed PI, 7/10 had negative MDR screening, 3/10 had infections caused by pathogens different from those identified in screening, and 2/10 developed infections with the same MDR bacteria despite appropriate prophylaxis.

Conclusions:

In patients undergoing percutaneous gastrostomy, TAP based on MDR colonization status did not reduce the incidence of PIs or MDR etiology compared with standard prophylaxis. Our findings question the role of colonization-guided prophylaxis in percutaneous gastrostomy and underscore the need for alternative preventive tactics in surgical site infection control.