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Infected G-tube
From WikEM
Contents
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
- Clogged G-tube
- Displaced G-tube
- Infected G-tube
- Leaking G-tube
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
- G-tube complications
- Clogged G-tube
- Displaced G-tube
- Infected G-tube
- Leaking G-tube
