Prophylactic Antibiotics for PEG Tube Placement: An Updated Meta-Analysis of Randomized Controlled Trials: 565

INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) tube placement is associated with a risk of infection. It is currently a standard of practice to administer prophylactic antibiotics with PEG tubeplacement. However, several recent studies have reported mixed results. We performed an updated meta-analysis to assess the efficacy of prophylactic antibiotics for PEG tube placement. METHODS: MEDLINE, Google scholar, Embase PubMed, Cochrane Database, and abstracts from gastroenterology scientific meetings were searched. Only randomized controlled trials (RCTs) of adult subjects comparing prophylactic antibiotics to no prophylactic antibiotics for PEG tube placement were included. Study quality was accessed by assigning a quality score. Two independent reviewers used standard forms to extract data and the differences were resolved by mutual agreement. Meta-analysis for the effects of prophylactic antibiotics was analyzed by calculating pooled risk or odds ratio for peristomal infections, systemic infections, and mortality using both fixed and random effects models. Heterogeneity among studies was assessed by calculating I 2 measure of inconsistency. Publication bias was also assessed. RESULTS: Thirteen RCTs (636 controls/764 treatment arm) met the inclusion criteria. All trials were published between 1985 and 2016. Eight trials predominantly used cephalosporins and 5 trials used penicillins. Eleven trials reported the technique of PEG tube placement: 8 used pull technique, 1 push technique, 1 both and 1 used the introducer method. In the treatment arm 1.07% of the patients got peristomal infection and in the control arm it was 2.55%. Prophylactic antibiotics with PEG tube placement resulted in a significant reduction in the risk of peristomal infection (RR 0.49, 95% CI: 0.39–0.63, P < 0.001, NNT = 8) and systemic infection. On subgroup analysis, both cephaloporins and penicillin based prophylaxis resulted in statistically significant reduction in risk of infections. Both single dose and multiple doses of antibiotics resulted in a reduction in the risk of infection. No significant difference was noted for mortality. Heterogeneity among studies was not significant. Funnel plots revealed no significant publication bias. Majority of the studies received a high score for quality. CONCLUSION: Current evidence supports the administration of prophylactic antibiotics prior to PEG tube placement. Further studies need to explore different PEG tube placement techniques that might obviate the need for antibiotics.