Infected G-tube

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 GS, IV antibiotics, tube may need to be removed
  • Necrotizing fasciitis: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement

See Also

References