Management of acute uncomplicated diverticulitis without antibiotics: compliance and outcomes -a retrospective cohort study
Azhar, Najia LU
; Aref, Hager
; Brorsson, Adam
; Lydrup, Marie-Louise
LU
; Jörgren, Fredrik
LU
; Schultz, Johannes Kurt
and Buchwald, Pamela
LU
(2022)
In BMC Emergency Medicine
22(1).
- Abstract
- Methods
Recent randomized control trials (RCTs) have confirmed that antibiotics in acute uncomplicated diverticulitis (AUD) neither accelerate recovery nor prevent complications or recurrences.
A retrospective cohort study was conducted, including all consecutive AUD patients hospitalized 2015- 2018 at Helsingborg Hospital (HH) and Skåne University Hospital (SUS), Sweden. HH had implemented a non-antibiotic treatment protocol in 2014 while SUS had not. Main outcomes were proportion of patients treated with antibiotics, complications, recurrences, and adherence to routinely colon evaluation.
Results
A total of 583 AUD patients were enrolled, 388 at SUS and 195 at HH. The diagnosis was CT-verified in 320 (83%) vs.... (More) - Methods
Recent randomized control trials (RCTs) have confirmed that antibiotics in acute uncomplicated diverticulitis (AUD) neither accelerate recovery nor prevent complications or recurrences.
A retrospective cohort study was conducted, including all consecutive AUD patients hospitalized 2015- 2018 at Helsingborg Hospital (HH) and Skåne University Hospital (SUS), Sweden. HH had implemented a non-antibiotic treatment protocol in 2014 while SUS had not. Main outcomes were proportion of patients treated with antibiotics, complications, recurrences, and adherence to routinely colon evaluation.
Results
A total of 583 AUD patients were enrolled, 388 at SUS and 195 at HH. The diagnosis was CT-verified in 320 (83%) vs. 186 (95%) patients respectively (p < 0.001). Forty-three (11%) and 94 (48%) of patients respectively did not receive antibiotics during hospitalization (p < 0.001). CRP was higher in the antibiotic group compared to the non-antibiotic group, both at admission and peak (90 mg/L vs 65 mg/L; p = 0.016) and (138 mg/L and 97 mg/L; p < 0.001). There were no significant differences in recurrences (22.0% vs. 22.6%; p = 0.87) and complications (2.5% vs. 2.9%; p = 0.77) between the antibiotic/non-antibiotic groups.
Conclusion
The structured treatment protocol led to reduced antibiotic use and a higher standard of care in terms of CT-verification. Clinicians’ compliance to the treatment protocol and best clinical practice was poor and warrants further studies. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4f04b2a6-3de7-4652-9d47-cfd016195f81
- author
- Azhar, Najia
LU
; Aref, Hager
; Brorsson, Adam
; Lydrup, Marie-Louise
LU
; Jörgren, Fredrik
LU
; Schultz, Johannes Kurt
and Buchwald, Pamela
LU
- organization
- publishing date
- 2022-02-21
- type
- Contribution to journal
- publication status
- published
- subject
- in
- BMC Emergency Medicine
- volume
- 22
- issue
- 1
- article number
- 28
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:35189812
- scopus:85125154841
- ISSN
- 1471-227X
- DOI
- 10.1186/s12873-022-00584-x
- language
- English
- LU publication?
- yes
- id
- 4f04b2a6-3de7-4652-9d47-cfd016195f81
- date added to LUP
- 2022-02-27 18:50:03
- date last changed
- 2022-04-20 18:24:24
@article{4f04b2a6-3de7-4652-9d47-cfd016195f81,
abstract = {{Methods<br/>Recent randomized control trials (RCTs) have confirmed that antibiotics in acute uncomplicated diverticulitis (AUD) neither accelerate recovery nor prevent complications or recurrences.<br/><br/>A retrospective cohort study was conducted, including all consecutive AUD patients hospitalized 2015- 2018 at Helsingborg Hospital (HH) and Skåne University Hospital (SUS), Sweden. HH had implemented a non-antibiotic treatment protocol in 2014 while SUS had not. Main outcomes were proportion of patients treated with antibiotics, complications, recurrences, and adherence to routinely colon evaluation.<br/><br/>Results<br/>A total of 583 AUD patients were enrolled, 388 at SUS and 195 at HH. The diagnosis was CT-verified in 320 (83%) vs. 186 (95%) patients respectively (p < 0.001). Forty-three (11%) and 94 (48%) of patients respectively did not receive antibiotics during hospitalization (p < 0.001). CRP was higher in the antibiotic group compared to the non-antibiotic group, both at admission and peak (90 mg/L vs 65 mg/L; p = 0.016) and (138 mg/L and 97 mg/L; p < 0.001). There were no significant differences in recurrences (22.0% vs. 22.6%; p = 0.87) and complications (2.5% vs. 2.9%; p = 0.77) between the antibiotic/non-antibiotic groups.<br/><br/>Conclusion<br/>The structured treatment protocol led to reduced antibiotic use and a higher standard of care in terms of CT-verification. Clinicians’ compliance to the treatment protocol and best clinical practice was poor and warrants further studies.}},
author = {{Azhar, Najia and Aref, Hager and Brorsson, Adam and Lydrup, Marie-Louise and Jörgren, Fredrik and Schultz, Johannes Kurt and Buchwald, Pamela}},
issn = {{1471-227X}},
language = {{eng}},
month = {{02}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Emergency Medicine}},
title = {{Management of acute uncomplicated diverticulitis without antibiotics: compliance and outcomes -a retrospective cohort study}},
url = {{http://dx.doi.org/10.1186/s12873-022-00584-x}},
doi = {{10.1186/s12873-022-00584-x}},
volume = {{22}},
year = {{2022}},
}