Discussion
pneumonia, TNF-α, inflammation, wound infection, bacteremia, infection
PNEUMONIA, INFLAMMATION, WOUND INFECTION, INFECTION, CAVITY
This is the first study to assess the efficacy of Betadine coating for preventing PEG peristomal infection. Our finding demonstrated that Betadine coating could not prevent peristomal infection or pneumonia. However, it could reduce serum level of CRP elevation after PEG. The microbes of mouth culture before PEG were highly correlated to microbes following infection, including pneumonia and peristomal wound infection. The Delta CRP at 24 h was the most important predictor of peristomal wound infection and all-cause infection within 14 days after PEG implantation.Several studies discussed reducing the contact between the PEG tube and the organisms in the oral cavity. Maetani et al. [However, in our study, we found Betadine coating on PEG tubes did not reduce peristomal wound infection. Previous studies have reported that Betadine irrigation before dental extraction or gingivectomy could reduce 30–40% of bacteremia [Although Betadine coating could not reduce peristomal wound infection or pneumonia, we did find a lower elevation of serum CRP level and N/L ratio after PEG implantation in the Betadine group. According to previous studies, povidone-iodine has not only an antibacterial effect but also an anti-inflammatory effect. It can suppress human inflammatory effector cells and mediators of inflammation such as TNF-α and β-galactosidase [There are several limitations in our study. First, it is a single center randomized controlled trial with small sample size. Second, there was no positive finding on the primary outcome, which might be owing to small sample size and inappropriate estimation of power. However, the post hoc analysis demonstrated that serum CRP change after PEG implantation could predict subsequent infection, which might be beneficial for clinical practice.In conclusion, a Betadine coating gastrostomy tube can reduce CRP elevation after PEG implantation but can not reduce peristomal infection. The change of serum CRP level after PEG can predict peristomal wound infection and pneumonia. The microbes of mouth culture are highly correlated with the pathogen of subsequential pneumonia and wound infection. The efficacy of povidone-iodine coating gastrostomy tube should be re-evaluated under an appropriately powered study in the future. Whether pre-emptive antibiotics are needed to abort potential infection in patients with elevation of CRP after PEG is deserved further study.