Infected G-tube - Revision history

Ostermayer: Prepared the page for translation

2026-01-04T23:09:40Z

Prepared the page for translation

← Revisión anterior		Revisión del 23:09 4 ene 2026
Línea 1:		Línea 1:
			<languages/>
			<translate>

	==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
Línea 7:		Línea 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 ([[rash\|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 [[sepsis\|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==

			</translate>
	{{DDX G-tube}}		{{DDX G-tube}}
			<translate>


	==Evaluation==		==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 [[cephalosporin]] or [[quinolone]]		*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 surgery, IV antibiotics, tube may need to be removed
	*[[Necrotizing fasciitis]]: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement		*[[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]]		[[Category:Surgery]]
			</translate>

Rossdonaldson1: /* See Also */

2019-10-29T17:13:23Z

ClaireLewis at 16:36, 28 October 2019

2019-10-28T16:36:12Z

← Revisión anterior		Revisión del 16:36 28 oct 2019
Línea 9:		Línea 9:

	==Clinical Features==		==Clinical Features==
	*Most infections are minor (erythema, tenderness, and purulent exudate at g-tube site)		*Most infections are minor ([[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 [[peritonitis]]
	*Necrotizing fasciitis (worsening edema, worsening erythema, bullae, soft tissue emphysema)		*[[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		*[[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''		''Note: An infected tube may be a nidus of [[bacteremia]]: consider PEGs as a possible source in the [[sepsis\|septic]] patient''

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 26:		Línea 26:
	==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 cephalosporin or quinolone		*Antibiotic choices generally include a first-generation [[cephalosporin]] or [[quinolone]]
	*MRSA coverage may be indicated on a center-dependent basis		*[[MRSA]] coverage may be indicated on a center-dependent basis

	==Disposition==		==Disposition==
	*Cellulitis: Consult GI or GS, IV antibiotics, tube may need to be removed		*[[Cellulitis]]: Consult GI or surgery, IV antibiotics, tube may need to be removed
	*Necrotizing fasciitis: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement		*[[Necrotizing fasciitis]]: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement

	==See Also==		==See Also==

ClaireLewis: /* References */

2019-09-29T21:32:05Z

References

← Revisión anterior		Revisión del 21:32 29 sep 2019
Línea 44:		Línea 44:

	[[Category:ID]][[Category:GI]]		[[Category:ID]][[Category:GI]]
			[[Category:Surgery]]

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T03:29:20Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 03:29 22 jul 2016
Línea 20:		Línea 20:
	{{DDX G-tube}}		{{DDX G-tube}}

	==~~Diagnosis~~==		==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

ClaireLewis: /* Disposition */

2016-07-14T01:18:51Z

Disposition

← Revisión anterior		Revisión del 01:18 14 jul 2016
Línea 30:		Línea 30:

	==Disposition==		==Disposition==
	*Cellulitis: Consult GI or GS, IV ~~abx~~, tube may need to be removed		*Cellulitis: Consult GI or GS, IV antibiotics, tube may need to be removed
	*Necrotizing fasciitis: Immediate ~~abx~~, consider MRI to confirm dx, surgical debridement		*Necrotizing fasciitis: Immediate antibiotics, consider MRI to confirm diagnosis, surgical debridement

	==See Also==		==See Also==

ClaireLewis: /* Management */

2016-07-14T01:18:35Z

Management

← Revisión anterior		Revisión del 01:18 14 jul 2016
Línea 26:		Línea 26:
	==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
	*~~ABX~~ choices generally include a first-generation cephalosporin or quinolone		*Antibiotic choices generally include a first-generation cephalosporin or quinolone
	*MRSA coverage may be indicated on a center-dependent basis		*MRSA coverage may be indicated on a center-dependent basis

Neil.m.young at 19:03, 31 January 2016

2016-01-31T19:03:59Z

← Revisión anterior		Revisión del 19:03 31 ene 2016
Línea 1:		Línea 1:
	==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
	*oropharyngeal or esophageal obstruction		**oropharyngeal or esophageal obstruction
	*major facial trauma		**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

	~~A PEG~~ may ~~also be placed for:~~		==Clinical Features==
	*~~passive gastric decompression~~		*Most infections are minor (erythema, tenderness, and purulent exudate at g-tube site)
	*~~mechanical apposition~~ of the ~~stomach to the abdominal wall to prevent hiatal herniation.~~		*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==
			{{DDX G-tube}}

	~~Most PEGs are 18F to 28F~~ and ~~may be used for 12-24mo.~~		==Diagnosis==
			*Diagnosis is based on exam and ancillary markers of infection
			*Consider bacterial and fungal cultures

			==Management==
	~~General complications include:~~		*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
	*wound infection		*ABX choices generally include a first-generation cephalosporin or quinolone
	*necrotizing fasciitis
	*peritonitis
	*aspiration +/- pneumonia
	*leaks
	*dislodgment
	*bowel perforation
	*enteric fistulas
	*bleeding
	*gastric outlet obstruction
	*small bowel obstruction
	*ileus
	*esophageal or gastric perforation
	*buried bumper syndrome
	*fistula
	*gastric herniation through the stoma

	==~~Clinical Features:==~~
	~~Physical exam may be significant for erythema, tenderness, and purulent exudate.~~

	~~==Differential Diagnosis:~~==
	*~~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)
	*deep infection with 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

	~~==Diagnosis/Workup:==~~
	~~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, ~~signs of~~ necrotizing fasciitis, or the infection does not respond to antibiotic treatment.
	*Most infections are minor
	*ABX choices generally include a first generation cephalosporin or quinolone
	*MRSA coverage may be indicated on a center-dependent basis		*MRSA coverage may be indicated on a center-dependent basis

	==Disposition:==		==Disposition==
	*Cellulitis: ~~consult~~ GI or GS, IV abx, tube may need to be removed ~~(see above)~~		*Cellulitis: Consult GI or GS, IV abx, tube may need to be removed
	*Necrotizing fasciitis: ~~immediate~~ abx, consider MRI to confirm dx, surgical debridement		*Necrotizing fasciitis: Immediate abx, consider MRI to confirm dx, surgical debridement

	==See Also==		==See Also==
	*[[G-tube complications]]		*[[G-tube complications]]
	*[[~~Clogged feeding tube\|~~Clogged G-tube]]		*[[Clogged G-tube]]
	*[[Displaced G-tube]]		*[[Displaced G-tube]]
	*[[Infected G-tube]]		*[[Infected G-tube]]
	*[[Leaking G-tube]]		*[[Leaking G-tube]]

	==References:==		==References==
	<Bistrian B.R., Hoffer L, Driscoll D.F. (2015). Enteral and Parenteral Nutrition Therapy. In Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J (Eds),Harrison's Principles of Internal Medicine, 19e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1130&Sectionid=63653665./>		<references/>

	<Corbett* S.A. (2014). Systemic Response to Injury and Metabolic Support. InBrunicardi F, Andersen D.K., Billiar T.R., Dunn D.L., Hunter J.G., Matthews J.B., Pollock R.E. (Eds), Schwartz's Principles of Surgery, 10e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=980&Sectionid=59610843./>

	<Cruz E.S., Stolzenberg D, Moon D (2015). Medical Emergencies in Rehabilitation Medicine. In Maitin I.B., Cruz E (Eds), CURRENT Diagnosis & Treatment: Physical Medicine & Rehabilitation. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1180&Sectionid=70382621./>

	<DeLegge, M.H. Gastrostomy tubes: Complications and their management. UpToDate. Accessed: 01/23/16. Last updated: Apr 15, 2015. https://www-uptodate-com.foyer.swmed.edu/contents/gastrostomy-tubes-complications-and-their-management?source=search_result&search=gastrostomy+tube&selectedTitle=2~142/>

	~~<Witting M.D. (2016). Gastrointestinal Procedures and Devices. In Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. (Eds), Tintinalli’s Emergency Medicine~~: ~~A Comprehensive Study Guide, 8e. Retrieved January 23, 2016 fromhttp~~:~~//accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1658&Sectionid=109433184./>~~		[[Category:ID]][[Category:GI]]

Neil.m.young at 17:43, 31 January 2016

2016-01-31T17:43:55Z

← Revisión anterior		Revisión del 17:43 31 ene 2016
Línea 55:		Línea 55:
	*Necrotizing fasciitis: immediate abx, consider MRI to confirm dx, surgical debridement		*Necrotizing fasciitis: immediate abx, consider MRI to confirm dx, surgical debridement

	==See Also:==		==See Also==
	~~https://wikem.org/wiki/Clogged_feeding_tube~~		*[[G-tube complications]]
			*[[Clogged feeding tube\|Clogged G-tube]]
	~~https://www.wikem.org/wiki/Displaced_G~~-tube		*[[Displaced G-tube]]
			*[[Infected G-tube]]
			*[[Leaking G-tube]]

	==References:==		==References:==

Mary Billington: Created page

2016-01-27T04:00:29Z

Created page

Página nueva

==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

A PEG may also be placed for:
*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.

General complications include:
*wound infection
*necrotizing fasciitis
*peritonitis
*aspiration +/- pneumonia
*leaks
*dislodgment
*bowel perforation
*enteric fistulas
*bleeding
*gastric outlet obstruction
*small bowel obstruction
*ileus
*esophageal or gastric perforation
*buried bumper syndrome
*fistula
*gastric herniation through the stoma

==Clinical Features:==
Physical exam may be significant for erythema, tenderness, and purulent exudate.

==Differential Diagnosis:==
*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)
*deep infection with 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

==Diagnosis/Workup:==
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, signs of necrotizing fasciitis, or the infection does not respond to antibiotic treatment.
*Most infections are minor
*ABX 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 abx, tube may need to be removed (see above)
*Necrotizing fasciitis: immediate abx, consider MRI to confirm dx, surgical debridement

==See Also:==
https://wikem.org/wiki/Clogged_feeding_tube

https://www.wikem.org/wiki/Displaced_G-tube

==References:==
<Bistrian B.R., Hoffer L, Driscoll D.F. (2015). Enteral and Parenteral Nutrition Therapy. In Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J (Eds),Harrison's Principles of Internal Medicine, 19e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1130&Sectionid=63653665./>

<Corbett* S.A. (2014). Systemic Response to Injury and Metabolic Support. InBrunicardi F, Andersen D.K., Billiar T.R., Dunn D.L., Hunter J.G., Matthews J.B., Pollock R.E. (Eds), Schwartz's Principles of Surgery, 10e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=980&Sectionid=59610843./>

<Cruz E.S., Stolzenberg D, Moon D (2015). Medical Emergencies in Rehabilitation Medicine. In Maitin I.B., Cruz E (Eds), CURRENT Diagnosis & Treatment: Physical Medicine & Rehabilitation. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1180&Sectionid=70382621./>

<DeLegge, M.H. Gastrostomy tubes: Complications and their management. UpToDate. Accessed: 01/23/16. Last updated: Apr 15, 2015. https://www-uptodate-com.foyer.swmed.edu/contents/gastrostomy-tubes-complications-and-their-management?source=search_result&search=gastrostomy+tube&selectedTitle=2~142/>

<Witting M.D. (2016). Gastrointestinal Procedures and Devices. In Tintinalli J.E., Stapczynski J, Ma O, Yealy D.M., Meckler G.D., Cline D.M. (Eds), Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Retrieved January 23, 2016 fromhttp://accessmedicine.mhmedical.com.foyer.swmed.edu/content.aspx?bookid=1658&Sectionid=109433184./>

← Revisión anterior		Revisión del 17:13 29 oct 2019
Línea 35:		Línea 35:
	==See Also==		==See Also==
	*[[G-tube complications]]		*[[G-tube complications]]
	*[[Clogged G-tube]]
	*[[Displaced G-tube]]
	*[[Infected G-tube]]
	*[[Leaking G-tube]]

	==References==		==References==