Is There an Impact of the Duration of Antibiotic Therapy on the Outcome of Nonsurgical Treatment of Complicated Diverticulitis?
Journal
Surgical laparoscopy, endoscopy & percutaneous techniques
ISSN: 1534-4908
Titre abrégé: Surg Laparosc Endosc Percutan Tech
Pays: United States
ID NLM: 100888751
Informations de publication
Date de publication:
27 Sep 2021
27 Sep 2021
Historique:
received:
25
02
2021
accepted:
18
06
2021
pubmed:
28
9
2021
medline:
8
2
2022
entrez:
27
9
2021
Statut:
epublish
Résumé
Patients treated nonsurgically for complicated diverticulitis are managed by antibiotics. However, there are no recommendations concerning their duration. We aimed to determine the impact of the duration of antibiotic therapy on the risk of failure of nonsurgical treatment of complicated acute diverticulitis. This was a single-center retrospective study of patients with computer tomography (CT)-diagnosed complicated diverticulitis between January 2015 and April 2020. Treatment failure was defined as early recurrence and/or a persistent abscess by control CT. In total, 148 patients fulfilled the inclusion criteria [87 men (58.8%), mean age 55±15 y]. The diverticulitis was classified as Hinchey I in 41.9%, Hinchey II in 9.5%, and pericolic free air in 48.6% of cases. The median abscess size was 2.9±1.7 cm. The median duration of antibiotic treatment was 10±4.2 days. The median follow-up was 64±60 months. The rate of failure was 12.8%. In univariate analysis, treatment >10 days (P=0.015) and an abscess >3 cm (P=0.032) were associated with a risk of treatment failure. In multivariate analysis, only the diameter of the abscess remained associated with a risk of failure (odds ratio: 1.6, 95% confidence interval: 1.09-2.4, P=0.01). This study suggests that there is no need to extend the duration of antibiotic treatment beyond 10 days in nonsurgically treated complicated acute diverticulitis.
Sections du résumé
BACKGROUND
BACKGROUND
Patients treated nonsurgically for complicated diverticulitis are managed by antibiotics. However, there are no recommendations concerning their duration. We aimed to determine the impact of the duration of antibiotic therapy on the risk of failure of nonsurgical treatment of complicated acute diverticulitis.
PATIENTS AND METHODS
METHODS
This was a single-center retrospective study of patients with computer tomography (CT)-diagnosed complicated diverticulitis between January 2015 and April 2020. Treatment failure was defined as early recurrence and/or a persistent abscess by control CT.
RESULTS
RESULTS
In total, 148 patients fulfilled the inclusion criteria [87 men (58.8%), mean age 55±15 y]. The diverticulitis was classified as Hinchey I in 41.9%, Hinchey II in 9.5%, and pericolic free air in 48.6% of cases. The median abscess size was 2.9±1.7 cm. The median duration of antibiotic treatment was 10±4.2 days. The median follow-up was 64±60 months. The rate of failure was 12.8%. In univariate analysis, treatment >10 days (P=0.015) and an abscess >3 cm (P=0.032) were associated with a risk of treatment failure. In multivariate analysis, only the diameter of the abscess remained associated with a risk of failure (odds ratio: 1.6, 95% confidence interval: 1.09-2.4, P=0.01).
CONCLUSION
CONCLUSIONS
This study suggests that there is no need to extend the duration of antibiotic treatment beyond 10 days in nonsurgically treated complicated acute diverticulitis.
Identifiants
pubmed: 34570071
doi: 10.1097/SLE.0000000000001007
pii: 00129689-202202000-00015
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
84-88Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Commane DM, Arasaradnam RP, Mills S, et al. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J Gastroenterol. 2009;15:2479–2488.
Loffeld RJ. Long-term follow-up and development of diverticulitis in patients diagnosed with diverticulosis of the colon. Int J Colorectal Dis. 2016;31:15–17.
Shahedi K, Fuller G, Bolus R, et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol. 2013;11:1609–1613.
Ambrosetti P. Value of CT for acute left-colonic diverticulitis: the surgeon’s view. Dig Dis. 2012;30:51–55.
Eglinton T, Nguyen T, Raniga S, et al. Patterns of recurrence in patients with acute diverticulitis. Br J Surg. 2010;97:952–957.
Trenti L, Kreisler E, Galvez A, et al. Long-term evolution of acute colonic diverticulitis after successful medical treatment. World J Surg. 2015;39:266–274.
Klarenbeek BR, de Korte N, van der Peet DL, et al. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis. 2012;27:207–214.
Sartelli M, Catena F, Ansaloni L, et al. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting. World J Emerg Surg. 2016;11:37.
Galetin T, Galetin A, Vestweber KH, et al. Systematic review and comparison of national and international guidelines on diverticular disease. Int J Colorectal Dis. 2018;33:261–272.
Feingold D, Steele SR, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57:284–294.
Francis N, Sylla P, Abou-Khalil M, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc. 2019;33:2726–2741.
Prise en charge médicale et chirurgicale de la diverticulite colique. Méthode Recommandations pour la pratique clinique [French Guidelines for the management of acute diverticulitis]. HAS 2017.
Lamb MN, Kaiser AM. Elective resection versus observation after nonsurgical management of complicated diverticulitis with abscess: a systematic review and meta-analysis. Dis Colon Rectum. 2014;57:1430–1440.
Devaraj B, Liu W, Tatum J, et al. Medically treated diverticular abscess associated with high risk of recurrence and disease complications. Dis Colon Rectum. 2016;59:208–215.
Lambrichts DPV, Bolkenstein HE, Van der Does DCHE, et al. Multicentre study of non-surgical management of diverticulitis with abscess formation. Br J Surg. 2019;106:458–466.
Coccolini F, Trevisan M, Montori G, et al. Mortality rate and antibiotic resistance in complicated diverticulitis: report of 272 consecutive patients worldwide: a prospective cohort study. Surg Infect (Larchmt). 2017;18:716–721.
Brandt D, Gervaz P, Durmishi Y, et al. Percutaneous CT scan-guided drainage vs. antibiotherapy alone for Hinchey II diverticulitis: a case-control study. Dis Colon Rectum. 2006;49:1533–1538.