Diarrhea Protocol

DOCUMENTATION CLARIFICATION FOR TRAUMA REGISTRY DATA

PEG Antibiotics

Guideline for Prophylactic Antibiotic for Percutaneous Endoscopic Gastrostomy

Translocation of endogenous microbial flora can occur during endoscopic procedures such as percutaneous endoscopic gastrostomy (PEG).1   While endoscopic related bacteremia carries a low risk, with certain patient comorbidities and history of previous procedures the risk increases.
Antibiotic prophylaxis can be useful for prevention of infections related to some invasive procedures and in specific clinical scenarios.  Patients undergoing PEG tube placement are at higher risk of bacteremia related to advanced age, compromised nutritional status, immunosuppression, and comorbidities.1 Prophylactic antibiotic therapy is recommended for these patients.1,2   The therapy is recommended as pre-procedural and as a one-time dose.1,2   Cefazolin that provides coverage for cutaneous organisms is adequate for this therapy.  In patients with methicillin-resistant Staphylococcus aureus (MRSA) decontamination is recommended.

Recommended antibiotic regimen:
Cefazolin 2g IV for patients weighing less than 120 kg
Cefazolin 3g IV for patients weighing 120 kg or greater
If a history of a severe allergy to penicillin is present, one of the following regimens may be used:
Clindamycin 900 mg IV or Vancomycin 15 mg/kg IV
PLUS
Gentamicin 5mg/kg IV or Aztreonam 2g IV or Levofloxacin 500 mg IV

1.     Antibiotic prophylaxis will be used in all patients receiving a PEG placement in the OR, endoscopy suite, and ICUs.
2.     Antibiotics dosing should be weight-adjusted
3.     Antibiotic administration should occur within 60 minutes prior to incision, with the exception of vancomycin and fluoroquinolones which should be administered within 120 minutes prior to incision.
4.     The antibiotic infusion should be complete before incision.
5.     Post procedure antibiotics are not warranted outside of a present infection or contaminated procedure

References:
1.     American Society of Gastrointestinal Endoscopy. Antibiotic prophylaxis for GI endoscopy. Gastrointestinal Endoscopy. 2015 81(1): 81-89. http://dx.doi.org/10.16/j.gie.2014.08.008
2.     Ban, KA; Minei, JP; Laronga, C; Harbrecht, BG; Jensen, EH; et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 update. Amer Coll Surgeons. 2016; 10: 59-73. http://dx.doi.org/10.1016/j.jamcollsurg.2016.10.029
3.     Bratzler DW; Dellinger EP; Olsen KM; et al. Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. AM J Health Syst Pharm. 2013 70(3):195-283. DOI: