A national evaluation of the implementation of guideline recommendations towards antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy and jejunostomy tube placement.

Abstract

Percutaneous endoscopic gastrostomy (PEG) and percutaneous endoscopic jejunostomy (PEJ) tube placement are standard procedures for artificially administered nutrition support in malnourished patients. However, minor and major complications can occur. Peristomal infections are most common, potentially leading to severe inflammation, hospitalization, and PEG/PEJ removal. Antibiotic prophylaxis is effective in preventing peristomal infections and recommended by current guidelines but does not seem to be systematically used. The present study evaluated the implementation of prophylactic antibiosis in PEG/PEJ placement in clinical routine in Germany. A web-based survey was conducted among hospitals, ambulatory health care centers, and focus practice. In total, 107 participants have finalized the questionnaire. Most participants were from major regional and maximum care facilities (36.4%), basic and standard care facilities (28.0%), as well as university facilities (23.4%). Routine antibiotic prophylaxis for every PEG/PEJ procedure is performed by 42.6%, whereas 13.9% do not apply antibiotic prophylaxis in general, and 23.8% only use it in patients with risk factors for infectious complications. This decision is based on in-house guidelines in 34.0% of participants or national recommendations 20.2%, whereas international guidelines (8.5%) and other recommendations play a minor role (4.3%). Although prophylactic antibiosis in PEG/PEJ placement is effective and recommended by current guidelines, less than half of the sites reported to routinely apply it. Given that these recommendations are based on outdated evidence, updated data is needed, and guideline recommendations need to be re-evaluated accordingly and fully implemented.