Antibiotic Prophylaxis for Percutaneous Radiologic Gastrostomy and Gastrojejunostomy Insertion in Outpatients with Head and Neck Cancer

Purpose To determine the effect of antibiotic prophylaxis on the postprocedural infection rate after fluoroscopically guided percutaneous radiologic gastrostomy and gastrojejunostomy with gastropexy performed as an outpatient procedure in ambulatory patients with head and neck cancer. Materials and Methods Medical and imaging records of all outpatients with head and neck cancer referred for gastrostomy or gastrojejunostomy from February 2003 to November 2004 were retrospectively reviewed. A 14-F percutaneous gastrostomy was inserted through the anterior abdominal wall after T-fastener gastropexy. Fifty-seven patients (36 men; mean age, 57.2 years; age range, 17–76 y) had 53 percutaneous radiologic gastrostomies and four percutaneous radiologic gastrojejunostomies. Mean follow-up was 27 weeks (range, 4–62 weeks). Thirty-seven patients received antibiotic prophylaxis with 1 g cefazolin intravenously and twice-daily cephalexin 500 mg for 5 days orally or via gastrostomy ( n = 35) or clindamycin 600 mg intravenously and 600 mg twice daily orally or via gastrostomy for 5 days ( n = 2). Results Ten minor postprocedural complications occurred in 8 patients (14%). There was a 15% peristomal infection rate ( n = 3) in patients who did not receive antibiotic prophylaxis; none occurred in those who received antibiotic prophylaxis. There were significantly fewer infections in the group that received antibiotic prophylaxis ( P = .039). No major complications or deaths occurred. Conclusions Administration of prophylactic antibiotics for percutaneous radiologic gastrostomy placement reduces peristomal infection in patients with head and neck cancer.