PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG) IN CHILDREN WITHOUT THE USE OF PROPHYLACTIC ANTIBIOTICS

Abstract

68 PEG is being performed with increasing frequency in children. The placement of PEG is routinely preceded by the administration of I.V. antibiotics. Methods: A total of 29 children underwent PEG placement over a 3 year period without the use of IV antibiotics. 3 children were excluded because they were already on antibiotics for other illnesses. There were 15 males and 11 females, age 1 mo to 19.8 years (mean=7.02years) and weights 2.5 to 70kg (mean=20.75). All children had a CBC and barium upper GI series prior to PEG placement. The procedure was performed under general anesthesia. The two types of PEGs used were the pull type (Bard®) or the push type (Wilson-Cook®). 15 Fr PEG was placed in children ≤15kg and 20 Fr PEG for >15kg. G-tube feeding was started 6hrs after the procedure. All children were examined on the second day after the procedure for G-tube site infections (GTSI) and for feed tolerance. Children were discharged if there were no signs of GTSI and if they tolerated two feeds of Pedialyte and a third feed of a polymeric formula. Parents were advised on the care of the G-tube and G-tube site and were educated to watch for signs of GTSI and asked to call if there were any concerns. There was a follow-up examination within 5 days. Subsequent follow-up period ranged from 2 to 35 months (mean=18.3). Gastrostomy site infection was considered to be present if there was erythema and exudate, with or without tenderness. Treatment of infection was based on clinical signs. GTSI that occurred within 30 days of the procedure were considered early, and those occurring after 30 days as late. Data were collected retrospectively. Results: 6 children had GTSI. Of these, 4 had early infections, all occuring within 8 days of G-tube placement. 2 out of these 4 children were <4mo old. There were 2 late GTSI that occured two and three months post-op. Infections were treated with antibiotics. None had peritonitis or required G-tube removal. Conclusion: Infants less than 4 months may be at risk of early site infection at the G-tube site. In children older than 1 yr, 8.3% (2/24) had G-tube site infection. However, further prospective double blinded studies are required to see if prophylactic antibiotics are required for PEG placement.