Juergen Barnert

4730 Antibiotic prophylaxis in percutaneous endoscopic gastrostomy in patients with malignant tumors.

The use of ABP in reducing local wound infection rates after PEG insertion is controversial. Previous observations suggested that patients with malignant tumors are at high risk of developing local infections after receiving a PEG. Aim of this study was to test if patients with malignant tumors benefit from an ABP prior to PEG insertion. Methods: Prospective randomized study with 25 patients with malignant tumors receiving their first PEG (thread pull method). Group 1 received an ABP with 2g cefotiam i.v. prior to PEG insertion, group 2 received no ABP. The rate and severity of local infections in the 4 days after PEG insertion were estimated by a score (value 0-21) consisting of the following parameters: Signs of infection at the site of insertion (0-4), local pain (0-3), systemic complications (0-2), body temperature (0-4) and rise in blood leucocytes (0-4) and CRP (0-4) between day 0 and 4 after PEG insertion. Results: Local infections occurred in 11/25 pts (44%): in group 1 in 4/14 pts (29%) and in group 2 in 7/11 pts (63%). Severe local infections were not observed in group 1, but occurred in 5 pts in group 2 (3 purulent secretions, 2 erythemata with secretion). The mean score value in group 1 (2.5±0.8) was significantly lower (p=0.019, Mann-Whitney test) than in group 2 (5.9±1.1)(Fig). The PEG had to be removed due to local infection in 2 pts in group 2, but in none of group 1. Conclusion: Patients with malignant tumors have a high risk of developing local infections after PEG insertion. An antibiotic propylaxis with cefotiam is able to lower the rate and particularly the severity of local infections. It should be recommended in all patients with malignant tumors.