Infected G-tube: Difference between revisions
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==Background== | ==Background== | ||
*The percutaneous gastrostomy tube (PEG) is commonly indicated in: | *The percutaneous gastrostomy tube (PEG) is commonly indicated in: | ||
**patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing | **patients with impaired ability to tolerate PO for caloric supplementation, hydration, frequent enteral medication dosing | ||
| Line 7: | Line 11: | ||
**mechanical apposition of the stomach to the abdominal wall to prevent hiatal herniation. | **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 | *Most PEGs are 18F to 28F and may be used for 12-24mo | ||
==Clinical Features== | ==Clinical Features== | ||
*Most infections are minor (erythema, tenderness, and purulent exudate at g-tube site) | |||
*Most infections are minor ([[Special:MyLanguage/rash|erythema]], tenderness, and purulent exudate at g-tube site) | |||
*Purulent stomal drainage secondary to an inflammatory foreign body reaction | *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) | *Leakage of gastric contents around the tube (causing irritation and requiring a larger tube size) | ||
*Deeper infection may show signs of peritonitis | *Deeper infection may show signs of [[Special:MyLanguage/peritonitis|peritonitis]] | ||
*Necrotizing fasciitis (worsening edema, worsening erythema, bullae, soft tissue emphysema) | *[[Special:MyLanguage/Necrotizing fasciitis|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 | *[[Special:MyLanguage/Fungal infection|Fungal infection]] is less common but can result in fungal peristomal [[Special:MyLanguage/cellulitis|cellulitis]], [[Special:MyLanguage/peritonitis|peritonitis]], and intra-abdominal [[Special:MyLanguage/abscesses|abscesses]] | ||
''Note: An infected tube may be a nidus of bacteremia: consider PEGs as a possible source in the septic patient'' | ''Note: An infected tube may be a nidus of [[Special:MyLanguage/bacteremia|bacteremia]]: consider PEGs as a possible source in the [[Special:MyLanguage/sepsis|septic]] patient'' | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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{{DDX G-tube}} | {{DDX G-tube}} | ||
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==Evaluation== | |||
*Diagnosis is based on exam and ancillary markers of infection | *Diagnosis is based on exam and ancillary markers of infection | ||
*Consider bacterial and fungal cultures | *Consider bacterial and fungal cultures | ||
==Management== | ==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 | *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 [[Special:MyLanguage/cephalosporin|cephalosporin]] or [[Special:MyLanguage/quinolone|quinolone]] | ||
*MRSA coverage may be indicated on a center-dependent basis | *[[Special:MyLanguage/MRSA|MRSA]] coverage may be indicated on a center-dependent basis | ||
==Disposition== | ==Disposition== | ||
*Cellulitis: Consult GI or | |||
*Necrotizing fasciitis: Immediate | *[[Special:MyLanguage/Cellulitis|Cellulitis]]: Consult GI or surgery, IV antibiotics, tube may need to be removed | ||
*[[Special:MyLanguage/Necrotizing fasciitis|Necrotizing fasciitis]]: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement | |||
==See Also== | ==See Also== | ||
*[[G-tube complications | |||
*[[Special:MyLanguage/G-tube complications|G-tube complications]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:ID]][[Category:GI]] | [[Category:ID]][[Category:GI]] | ||
[[Category:Surgery]] | |||
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Latest revision as of 23:09, 4 January 2026
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
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 surgery, IV antibiotics, tube may need to be removed
- Necrotizing fasciitis: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement
See Also