Introduction: To our knowledge, there is an absence of data evaluating the impact of pre-operative fever and leukocytosis as well as perioperative antibiotics (Abx) (prophylactic or scheduled) given prior to percutaneous endoscopic gastrostomy (PEG) on the incidence of surgical site infections in critically injured ICU patients.

Methods: Prospective data was collected on 215 trauma patients admitted to the Intensive care unit (ICU) of a major urban Level I trauma center who had undergone PEG placement in the ICU. Any use of prophylactic Abx for PEG placement and concurrently scheduled systemic Abx therapies were recorded. Maximum temperature and white blood cell count in the 24 hours prior to surgery were recorded. Fever was defined as temperature >101.4oF and leukocytosis was defined as a white blood cell count >11,000 K/UL. The diagnosis of a surgical site infection (PEG site) and resulting treatment were recorded. Fisher’s exact tests were performed to assess the relationship of antibiotic use, fever, and leukocytosis to surgical site infections.

Results: 215 patients were enrolled in the study in which an equal number of patients received antibiotics (n=107 or 50%) or no antibiotics (n=108 or 50%). Of the patients receiving antibiotics, 27 patients (25%) received only prophylactic antibiotics prior to PEG placement, 73 patients (68%) received only scheduled systemic Abx (no additional), while 7 patients (7%) received prophylactic antibiotics in addition to their scheduled systemic antibiotics. The majority of the study population had a documented fever (n=119 or 55%) or leukocytosis (n=127 or 59%) in the 24 hours prior to PEG placement. The overall incidence of surgical site infections was 5.1% (n=11). There was a four-fold decrease in the surgical site infection rate (1.9% vs. 8.3%) among patients who received antibiotics (prophylactic, scheduled systemic, or both) compared to those who did not. In addition, none of the patients who received prophylactic antibiotics (alone or in addition to scheduled systemic antibiotics) were diagnosed with a surgical site infection. The incidence of surgical site infections was not significantly increased in patients with pre-operative fever (p=0.117) and/or leukocytosis (p=0.762).

Conclusion: The incidence of surgical site infections is significantly decreased in trauma patients receiving Abx at the time of PEG placement. Pre-operative fever and/or leukocytosis is not a contraindication prior to PEG placement.