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Prospective Assessment of Peristomal Infections Using Objective Criteria
Author(s) -
Mundi Manpreet S.,
Seegmiller Sara,
Davidson Jacob,
Schneckloth Jill,
Saied Jessica,
Hurt Ryan T.
Publication year - 2018
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1020
Subject(s) - medicine , percutaneous endoscopic gastrostomy , antibiotics , enteral administration , prospective cohort study , body mass index , sepsis , surgery , parenteral nutrition , finance , peg ratio , microbiology and biotechnology , economics , biology
Background Enteral nutrition (EN) is a safe and cost‐effective intervention with significant morbidity and mortality benefit that can also be associated with complications. Peristomal infections can occur in 5%–30% of cases after percutaneous endoscopic gastrostomy placement. Despite this common occurrence, widespread use of objective diagnostic criteria is not prevalent, possibly leading to overuse of antibiotics. Methods All patients who were reporting symptoms consistent with peristomal infection were evaluated. Criteria based on erythema, induration, and exudates were applied with cumulative score ≥8 indicating peristomal infection. All patients were followed, with additional factors being collected if available. Results Forty‐three patients noted complaints consistent with peristomal infection. In patients with a score <8 (n = 16), only 2 required antibiotics (12.5%) and 1 patient was hospitalized (6.3%). In patients with a score ≥8 (n = 27), 16 had a score of 8 or 9; all patients responded to antibiotics (100%), and 1 was hospitalized (6.3%). In patients with a score ≥10, all (100%) were treated with antibiotics. Five of 11 (45%) patients were hospitalized, with the most common diagnosis being sepsis. Of the baseline variables analyzed, higher body mass index correlated with score ≥10 (26.36 ± 2.94 vs 22.91 ± 4.35 in score <9, P = .0128). Conclusions Objective criteria were effective in risk stratifying patients who presented with reports of peristomal infection. Patients with a score <8 tended to be at low risk, scores of 8–9 were of moderate risk, and patients with a score ≥10 were at high risk and required very close monitoring or hospitalization.