Systemic Antimicrobial Prophylaxis for Percutaneous Endoscopic Gastrostomy

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Table of Contents

Introduction
Justification of the Study
Relevance to Nursing Practice
The rigor of Studies Included in this Review
Study Design
Clarity of Study Presentation
Overall Findings of the Study
Conclusion and Relevance of the Review to Practice
References

Introduction

This paper is a critique of the article by Lipp and Lusardi (2013), which is titled, “Systematic Antimicrobial Prophylaxis for Percutaneous Endoscopic Gastrostomy” (PEG). The review was aimed at finding out whether peristomal infections would reduce if antimicrobials were administered systemically before PEG tube insertion. Lipp and Lusardi (2013) explained the PEG as a procedure that would help in the provision of nutritional elements for a short or long period. The system uses a sterile feeding tube that delivers medication or food in a liquid. The tube is normally introduced surgically via the anterior abdominal wall (Blomberg, Lagergren, Martin, Mattsson, & Lagergren, 2010). This definition is ideal in the introductory part, as it allows the audience to comprehend the topic that the article discusses. The definition is also given in simple terminology that is easily understood by anyone, whether in the medical profession or not.

Justification of the Study

The authors cited several reasons as the basis for their review. The first reason they provided was that patients undergoing PEG are at risk of contracting various infections. The risk is exacerbated by various factors, such as immunosuppression, age, a primary infection, such as diabetes mellitus or malignancy, or compromised state of food intake (Guarner-Argente et al. 2011). Furthermore, the authors described that the rising incidence of Methicillin-resistant Staphylococcus aureus (MRSA) has also heightened the risk of the surgical procedure and the discussions about the use of antibiotics during PEG tube placement (Diehl, Cheruvattath, Facktor, & Go, 2010). These reasons were sufficient enough to justify the review.

Furthermore, the authors correctly indicate that there are no up-to-date reports or guidelines on the actual concentration of an antimicrobial agent that can be used to prevent infections during the tube placement procedure (Coelho-Prabhu et al. 2013). The authors finally describe the main objective of surgical antimicrobial prophylaxis as the determination of a bactericidal concentration of an appropriate antimicrobial agent that can be used to protect a patient from potential peritoneal infections that may arise primarily due to the surgical procedure. These reasons, together with the definitions provided, are a sure and ideal basis for conducting the study. The reasons also help the audience to clearly understand the objective of the study.

Relevance to Nursing Practice

The results of this review have an impact on nursing practice, both in the research and clinical aspects. Nurses are the primary health professionals charged with the responsibility of taking care of patients. Since nurses must ensure patients achieve the desired clinical outcome quickly, it is only proper that mechanisms that can prevent the onset of other medical conditions other than the primary infection are developed. From the findings, the authors recommended that antibiotics should be administered routinely to all patients undergoing PEG tube placements, as antibiotics have been shown to reduce the incidences of peristomal infections.

Implementation of this recommendation will help patients who are predisposed to PEG tube insertion-related infections by protecting them from bacterial infections. Therefore, nurses will only focus on the management of the primary condition. This focus will help reduce the time the nurses spend on the patient and allow ample time to attend to other nursing duties. Also, prevention of a secondary infection will result in quick recovery of the patient. The patient, in return, will be cushioned against unnecessary medical procedures that could occur as a result of the secondary infection, as well as an unnecessary financial burden that could result. Eventually, the two parties (patient and nurse) will develop a good rapport and public confidence in nursing will improve.

Additional research, especially focusing on the pull method, is not necessary because the researchers’ findings are comprehensive. However, the authors recommend a comprehensive, randomized controlled trial that could provide a comparison between the pull and the push method. Also, the researchers recommend that a study comparing the utilization of antiseptics alongside antibiotics be conducted as literature has demonstrated that a combination of the two is strongly associated with better clinical outcomes. These recommendations are ideal as they can help researchers to focus on a particular area, rather than general research. Clinical outcomes will be improved if the recommended research is undertaken and results published.

The rigor of Studies Included in this Review

The number of studies employed was sufficient enough to address the topic of study. However, certain queries may arise. In the background, the authors indicated that one factor that may predispose a patient to the infection is age. Therefore, the inclusion of as low as 16 year-olds would not address the actual risk age. Also, the period selected for the publication of these articles was wide apart. A lot of clinical interventions may have developed between 1985 and 2010, owing to the vast technological advancements in the field of medicine. Therefore, it would not be ideal to compare the findings that were published in 1985 and 2010 and use both to conclude. The sample size of the studies was ideal, although the 1985 study had a very small sample size that could not be extrapolated to the general public independently. It was proper that both genders were included in all the studies; in the studies that had males only, it could have been prudent if the authors provided a rationale for the choice. Finally, though the content of the studies addressed the topic of study sufficiently, including studies from industrial countries alone may be a limitation. The results could have been more comprehensive if studies from third world countries could have been included too.

Study Design

Literature search to retrieve relevant studies was the ideal method for addressing the study question because this was a review. It was clear that the authors performed a comprehensive literature search through various detailed databases to retrieve the articles of interest. The search provided confidence that the findings were all-inclusive and based on scientific data that was well researched and published. The selection criteria made the findings more ideal. The inclusion of studies that strictly addressed the use of antimicrobial agents during the PEG procedure, but were not restricted to issues of race, gender, and year of publication, was ideal. Picking each of the studies independently, as well as analysis of the retrieved data avoided the chances of bias.

Clarity of Study Presentation

A major boost to the application of the study was the appropriate manner in which the study was presented. The subdivision of the report into various sections makes it easier for any reader to locate the point of interest. The abstract is presented, and it represents the actual content of the paper. In the abstract, the aim, rationale, method, main findings, and conclusion are provided. The methodology is also presented explicitly and makes it easier for the review to be reproduced. The findings are also provided with each specific area addressed independently. All the tables are explained in a language that can be understood easily.

Overall Findings of the Study

The study included a total of 13 randomized controlled trials (RCTs) that used a total of 1637 patients as their study subjects. This sample size was sufficient to address the topic of interest. One can have confidence in the results because the peristomal infection was recorded in all the reviewed studies. The infections reduced substantially after administering antibiotics during the surgery, as twelve studies showed. One article was excluded from the review because it evaluated the effectiveness of antibiotics administered through the PEG and IV systems during tube insertion in the surgical procedure.

Conclusion and Relevance of the Review to Practice

The study showed that peristomal infections fell drastically after using antibiotics before the PEG insertion. All the studies that were reviewed were consistent regarding the finding. This conclusion was ideal, based on the review findings and the pooled outcome of the analysis.

Regarding relevance to the field of practice, the authors only provided recommendations that prophylactic antibiotics should be used due to the demonstrated effects. However, the authors did not demonstrate the direct impact the study would have on the nursing profession. Concerning research, the authors provided a clear picture of how further research ought to be conducted to improve the clinical outcome in patients undergoing PEG tube placement procedures.

References

Blomberg, J., Lagergren, P., Martin, L., Mattsson, F., & Lagergren, J. (2010). Novel approach to antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): randomised controlled trial. British Medical Journal, 341, c3115. Web.

Coelho-Prabhu, N., Oxentenko, A. S., Osmon, D. R., Baron, T. H., Hanssen, A. D., Wilson, W. R…, Bebari, E. F. (2013). Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy. Acta Orthopaedica, 84(1), 82-86. Web.

Diehl, D. L., Cheruvattath, R., Facktor, M. A., & Go, B. D. (2010). Infection after endoscopic ultrasound-guided aspiration of mediastinal cysts. Interactive CardioVascular and Thoracic Surgery, 10(2), 338-340. Web.

Guarner-Argente, C., Shah, P., Buchner, A., Ahmad, N. A., Kochman, M. L., & Ginsberg, G. G. (2011). Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointestinal Endoscopy, 74(1), 81-86. Web.

Lipp, A., & Lusardi, G. (2013). Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database of Systematic Reviews. Web.

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