P0674 - Efficacy of Topical Antimicrobials in Preventing Peristomal Infections Associated With PEG Tube Placement: A Systematic Review and Meta-Analysis

Award: Presidential Poster Award

Islam Mohamed, MD¹, Faateh A. Rauf, MBBS², Ahmed El Telbany, MD, MPH³, Mohamed A. Refaat, BS⁴, Omar T. Ahmed, MD⁵, Hazem Abosheaishaa, MD⁶, Noor Hassan, MD⁷, Dushyant S. Dahiya, MD⁸, Divya Reddy, BA¹, Brandon Park, BA¹, Kali Kuhnert, BA¹, Hassan Ghoz, MD^9
1University of Missouri - Kansas City School of Medicine, Kansas City, MO; ²Icahn School of Medicine at Mount Sinai, Fresh Meadows, NY; ³University of New Mexico, Albuquerque, NM; ⁴University of Missouri - Kansas City School of Medicine, Blue Springs, MO; ⁵University of Illinois at Chicago, Chicago, IL; ⁶Icahn School of Medicine at Mount Sinai, Queens, NY; ⁷University of Missouri Kansas City School of Medicine, Kansas City, MO; ⁸The University of Kansas School of Medicine, Kansas City, KS; ⁹UMKC School of Medicine, Kansas City, MO

Introduction: Percutaneous endoscopic gastrostomy (PEG) involves inserting a feeding tube into the stomach for enteral feeding, serving as the primary method for long-term nutrition in patients unable to tolerate oral intake. Peristomal infections are the most common complication, occurring in up to 65% of cases in some studies. Prophylactic measures include preoperative antibiotics, site decontamination, and strict infection control. Our study aims to comprehensively analyze the efficacy of topical antimicrobials as an independent agent in preventing PEG tube peristomal infections.

Methods: Our systematic review and meta-analysis adhered to PRISMA guidelines and Cochrane Handbook methodology, with the protocol pre-registered on PROSPERO (CRD42023494080). A comprehensive search of Medline, Cochrane, SCOPUS, and EMBASE until January 18, 2023, utilized keywords related to topical antimicrobials and PEG tube infections. Inclusion criteria were patients with PEG insertion sites, topical antimicrobials or antiseptics use, and standard or alternative wound care, focusing on outcomes like efficacy, infection, induration, erythema, exudate, and pneumonia risk at 1 week in RCTs. Screening was conducted using the COVIDENCE tool, and bias was assessed with the RoB 2 tool. Statistical analysis was performed using RevMan v5.3, combining dichotomous outcomes via the odds ratio and a random-effect model with a 95% confidence interval, with statistical significance determined at P < 0.05. Heterogeneity was evaluated using Chi-square and I-square tests.

Results: We included 5 randomized controlled trials (RCTs) with 316 patients in our analysis. Topical antimicrobials showed no significant difference compared to placebo in terms of efficacy (OR: 2.03, CI [0.57, 7.23]), infection rates (OR: 0.47, CI [0.12, 1.87]), induration at 1 week (OR: 0.18, CI [0.03, 1.1]), erythema at 1 week (OR: 0.54, CI [0.05, 5.59]), exudate at 1 week (OR: 1.13, CI [0.20, 6.47]), and pneumonia risk (OR: 0.07, CI [0.07, 2.33]).

Discussion: Our study found that topical antimicrobial therapy did not improve outcomes in preventing PEG tube peristomal infections. Significant heterogeneity was noted due to the variety of topical agents and antiseptic techniques used. This evidence aligns with current guidelines, indicating that topical therapy alone is insufficient as a prophylactic measure for PEG tube insertion, with prophylactic antibiotic therapy remains the mainstay preventative measure.


Disclosures:


Islam Mohamed, MD¹, Faateh A. Rauf, MBBS², Ahmed El Telbany, MD, MPH³, Mohamed A. Refaat, BS⁴, Omar T. Ahmed, MD⁵, Hazem Abosheaishaa, MD⁶, Noor Hassan, MD⁷, Dushyant S. Dahiya, MD⁸, Divya Reddy, BA¹, Brandon Park, BA¹, Kali Kuhnert, BA¹, Hassan Ghoz, MD⁹. P0674 - Efficacy of Topical Antimicrobials in Preventing Peristomal Infections Associated With PEG Tube Placement: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.