Ostomy Site Infection - Causes, Treatment & When to See a Doctor

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What is Ostomy Site Infection?

An ostomy site infection (OSI) is a bacterial or fungal infection that develops around the opening (stoma) created during an ostomy surgery. The infection can involve the skin surrounding the stoma, the sub‑cutaneous tissue, or deeper structures such as the abdominal wall. OSIs are a relatively common postoperative complication, occurring in roughly 5–15 % of new ostomy patients, especially during the first 30 days after surgery.<sup>1</sup> Prompt recognition and treatment are essential because a minor skin irritation can progress to cellulitis, abscess formation, or sepsis if left untreated.

Common Causes

Many factors can predispose a person to an OSI. Below are the most frequently encountered causes:

• Surgical site contamination – bacteria from the skin or intestinal tract entering the wound during the operation.
• Poor stoma care hygiene – infrequent or improper cleaning of the peristomal skin.
• Improper appliance fit – leaks, gaps, or excessive pressure from the pouching system.
• Excessive moisture – from urine or stool that macerates the skin.
• Underlying chronic disease – diabetes, vascular disease, or immunosuppression (e.g., chemotherapy, steroids).
• Obesity or excess abdominal folds – makes it harder to achieve a seal and increases skin friction.
• Smoking – impairs wound healing and reduces blood flow to the area.
• Previous radiation therapy – damages local tissue and reduces its ability to fight infection.
• Allergic reaction to adhesive or pouch material – can cause dermatitis that mimics infection and increases susceptibility.
• Fungal overgrowth – especially Candida spp., which thrive in warm, moist environments.

Associated Symptoms

Patients with an OSI often notice a cluster of skin changes and systemic clues, including:

• Redness (erythema) spreading outward from the stoma.
• Swelling or warmth around the site.
• Increased pain or tenderness, especially when changing the pouch.
• Purulent or foul‑smelling discharge.
• Itching, burning, or a feeling of “tightness” under the appliance.
• Fever, chills, or feeling generally unwell (suggests systemic involvement).
• Bleeding or oozing that does not stop with gentle pressure.
• Changes in stoma appearance – e.g., edema, bruising, or ulceration.

When to See a Doctor

While minor irritation can often be managed at home, seek professional care promptly if you notice any of the following:

• Redness extending more than 2 cm from the stoma.
• Increasing pain despite proper appliance changes.
• Fever ≥ 38 °C (100.4 °F) or chills.
• Rapidly spreading swelling or a “streaking” pattern suggesting cellulitis.
• Visible pus, foul odor, or drainage that is thick and yellow/green.
• Difficulty fitting the pouch due to large amounts of exudate.
• Underlying conditions that impair healing (e.g., uncontrolled diabetes).
• Any sign of an abscess (a firm, tender lump under the skin).

Diagnosis

Healthcare providers use a combination of visual inspection, history, and sometimes laboratory tests to confirm an OSI.

Clinical Evaluation

• Physical exam – assessment of erythema, warmth, swelling, discharge, and stoma integrity.
• Symptom questionnaire – onset, progression, wound‑care routine, and systemic signs.

Laboratory & Imaging

• Wound cultures – swab of any purulent material to identify bacterial or fungal pathogens.
• Complete blood count (CBC) – elevated white‑blood‑cell count may indicate infection.
• Blood glucose check – especially in diabetic patients to assess control.
• Imaging (ultrasound or CT) – ordered if an abscess, deeper fascial infection, or intra‑abdominal complication is suspected.

Treatment Options

Management is tailored to the severity of the infection, the causative organism, and the patient’s overall health.

Medical Therapy

• Topical antibiotics – mupirocin, bacitracin, or silver‑impregnated dressings for mild, superficial infections.
• Oral antibiotics – usually a broad‑spectrum agent (e.g., amoxicillin‑clavulanate, ciprofloxacin + metronidazole) for moderate infections; choice guided by culture results when available.
• Antifungal medication – fluconazole or topical clotrimazole for confirmed Candida overgrowth.
• Analgesics – acetaminophen or NSAIDs (if not contraindicated) to control pain and inflammation.
• Adjunctive therapies – hyperbaric oxygen in refractory cases, though rarely needed.

Home & Supportive Care

• Clean the peristomal skin gently with warm water and a mild, fragrance‑free cleanser; pat dry.
• Apply a barrier cream (zinc oxide, silicone, or Cavilon™) before attaching a new appliance.
• Change the pouch at least every 3–4 days, or sooner if it becomes loose or saturated.
• Use a breathable, sterile dressing over the infected area if leakage is a problem.
• Maintain good glycemic control and stay hydrated to support healing.
• Quit smoking and limit alcohol, both of which impair wound healing.

Procedural Interventions

• Incision & drainage – required for abscesses or collections of pus.
• Stoma revision – in cases where poor placement or repeated breakdown prevents healing.
• Removal of necrotic tissue – performed by a wound‑care specialist if tissue death is present.

Prevention Tips

Many OSIs are avoidable with consistent skin care and proper appliance management.

• Choose the right pouching system – work with an ostomy nurse to select a size and type that fits your body shape.
• Inspect the skin daily – look for early signs of redness, maceration, or irritation.
• Keep the area clean and dry – wash with mild soap, rinse thoroughly, and apply a protective barrier before each pouch change.
• Change the appliance promptly when it feels loose, leaks, or after heavy sweating.
• Use skin‑friendly adhesives – hypoallergenic products reduce allergic dermatitis.
• Maintain a healthy weight – excess abdominal tissue can create folds that trap moisture.
• Control chronic illnesses – keep blood sugar, blood pressure, and cholesterol in target ranges.
• Avoid smoking – nicotine narrows blood vessels and slows tissue repair.
• Seek regular follow‑up – an ostomy nurse or surgeon should evaluate the stoma at least once a month during the first 6 months.
• Educate caregivers – anyone assisting with pouch changes should know proper technique and signs of infection.

Emergency Warning Signs

If any of the following occur, seek emergency care (e.g., urgent‑care clinic, emergency department, or call 911) immediately:

• Rapidly spreading redness or swelling that covers a large area of the abdomen.
• Severe, uncontrolled pain that does not improve with analgesics.
• High fever (≥ 39 °C / 102 °F) or chills accompanied by sweating.
• Signs of sepsis: confusion, rapid heartbeat, low blood pressure, or difficulty breathing.
• Visible pus or foul‑smelling drainage that suddenly increases in volume.
• Development of a hard, tender lump (possible abscess) that feels warm to the touch.
• Rapidly deteriorating general health, especially in patients with underlying immune compromise.

References

1. Mayo Clinic. “Ostomy care: Complications and how to avoid them.” Updated 2023.
2. Centers for Disease Control and Prevention. “Surgical site infection (SSI) event.” 2022.
3. National Institutes of Health. “Wound infection management.” 2021.
4. Cleveland Clinic. “Stoma care & troubleshooting.” Accessed 2024.
5. World Health Organization. “Guidelines for the prevention of surgical site infection.” 2020.

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