Infected G-tube: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Most infections are minor (erythema, tenderness, and purulent exudate at g-tube site) | *Most infections are minor ([[rash|erythema]], tenderness, and purulent exudate at g-tube site) | ||
*Purulent stomal drainage secondary to an inflammatory foreign body reaction | *Purulent stomal drainage secondary to an inflammatory foreign body reaction | ||
*Leakage of gastric contents around the tube (causing irritation and requiring a larger tube size) | *Leakage of gastric contents around the tube (causing irritation and requiring a larger tube size) | ||
*Deeper infection may show signs of peritonitis | *Deeper infection may show signs of [[peritonitis]] | ||
*Necrotizing fasciitis (worsening edema, worsening erythema, bullae, soft tissue emphysema) | *[[Necrotizing fasciitis]] (worsening edema, worsening erythema, bullae, soft tissue emphysema) | ||
*Fungal infection is less common but can result in fungal peristomal cellulitis, peritonitis, and intra-abdominal abscesses | *[[Fungal infection]] is less common but can result in fungal peristomal [[cellulitis]], [[peritonitis]], and intra-abdominal [[abscesses]] | ||
''Note: An infected tube may be a nidus of bacteremia: consider PEGs as a possible source in the septic patient'' | ''Note: An infected tube may be a nidus of [[bacteremia]]: consider PEGs as a possible source in the [[sepsis|septic]] patient'' | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*The G-tube does not need to be removed routinely unless there are signs of peritonitis, necrotizing fasciitis, or the infection does not respond to initial antibiotic treatment | *The G-tube does not need to be removed routinely unless there are signs of peritonitis, necrotizing fasciitis, or the infection does not respond to initial antibiotic treatment | ||
*Antibiotic choices generally include a first-generation cephalosporin or quinolone | *Antibiotic choices generally include a first-generation [[cephalosporin]] or [[quinolone]] | ||
*MRSA coverage may be indicated on a center-dependent basis | *[[MRSA]] coverage may be indicated on a center-dependent basis | ||
==Disposition== | ==Disposition== | ||
*Cellulitis: Consult GI or | *[[Cellulitis]]: Consult GI or surgery, IV antibiotics, tube may need to be removed | ||
*Necrotizing fasciitis: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement | *[[Necrotizing fasciitis]]: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement | ||
==See Also== | ==See Also== | ||
*[[G-tube complications]] | *[[G-tube complications]] | ||
==References== | ==References== | ||
Latest revision as of 17:13, 29 October 2019
Background
- The percutaneous gastrostomy tube (PEG) is commonly indicated in:
- patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing
- oropharyngeal or esophageal obstruction
- major facial trauma
- passive gastric decompression
- mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation.
- Most PEGs are 18F to 28F and may be used for 12-24mo
Clinical Features
- Most infections are minor (erythema, tenderness, and purulent exudate at g-tube site)
- Purulent stomal drainage secondary to an inflammatory foreign body reaction
- Leakage of gastric contents around the tube (causing irritation and requiring a larger tube size)
- Deeper infection may show signs of peritonitis
- Necrotizing fasciitis (worsening edema, worsening erythema, bullae, soft tissue emphysema)
- Fungal infection is less common but can result in fungal peristomal cellulitis, peritonitis, and intra-abdominal abscesses
Note: An infected tube may be a nidus of bacteremia: consider PEGs as a possible source in the septic patient
Differential Diagnosis
G-tube complications
Evaluation
- Diagnosis is based on exam and ancillary markers of infection
- Consider bacterial and fungal cultures
Management
- The G-tube does not need to be removed routinely unless there are signs of peritonitis, necrotizing fasciitis, or the infection does not respond to initial antibiotic treatment
- Antibiotic choices generally include a first-generation cephalosporin or quinolone
- MRSA coverage may be indicated on a center-dependent basis
Disposition
- Cellulitis: Consult GI or surgery, IV antibiotics, tube may need to be removed
- Necrotizing fasciitis: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement