Treatment of acute uncomplicated diverticulitis without antibiotics: risk factors for treatment failure

Abstract

PurposeConservative treatment strategy without antibiotics in patients with uncomplicated diverticulitis (UD) has proven to be safe. The aim of the current study is to assess the clinical course of UD patients who were initially treated without antibiotics and to identify risk factors for treatment failure.MethodsA retrospective cohort study was performed including all patients with a CT-proven episode of UD (defined as modified Hinchey 1A). Only non-immunocompromised patients who presented without signs of sepsis were included. Patients that received antibiotics within 24 h after or 2 weeks prior to presentation were excluded from analysis. Patient characteristics, clinical signs, and laboratory parameters were collected. Treatment failure was defined as (re)admittance, mortality, complications (perforation, abscess, colonic obstruction, urinary tract infection, pneumonia) or need for antibiotics, operative intervention, or percutaneous abscess drainage within 30 days after initial presentation. Multivariable logistic regression analyses were used to quantify which variables are independently related to treatment failure.ResultsBetween January 2005 and January 2017, 751 patients presented at the emergency department with a CT-proven UD. Of these, 186 (25%) patients were excluded from analysis because of antibiotic treatment. A total of 565 patients with UD were included. Forty-six (8%) patients experienced treatment failure. In the multivariable analysis, a high CRP level (> 170 mg/L) was a significant predictive factor for treatment failure.ConclusionUD patients with a CRP level > 170 mg/L are at higher risk for non-antibiotic treatment failure. Clinical physicians should take this finding in consideration when selecting patients for non-antibiotic treatment.

International Consensus on Diverticulosis and Diverticular Disease. Statements from the 3rd International Symposium on Diverticular Disease

“…These statements focused their attention on three topics under active debate. The first statement claims about the safety of ambulatory treatment of uncomplicated AD, which is safe and effective [73][74][75][76][77][78][79]. Moreover, this approach has also a significant impact on cost-saving [79].…”

Rifamycin vs placebo for the treatment of acute uncomplicated diverticulitis: A randomised, double‐blind study

“…In order to evaluate risk factors in those patients who experienced non‐antibiotic treatment failure, a retrospective cohort study of 565 patients with CT‐proven AUD who were initially treated with antibiotics was carried out (30‐day follow up) 29 . In a multivariable analysis of the study, patients with AUD and a CRP level >170 mg/L were found to be at higher risk for non‐antibiotic treatment failure 29 . Despite such studies to identify risk factors that may help clinical decision making, the impact of acute episodes of diverticulitis on patients’ quality of life renders observational, non‐interventional treatment decisions difficult for both patients and physicians.…”

Hot Topics in Surgical Management of Acute Diverticulitiss

“…There is some evidence that high C-reactive protein (CRP) level (>170 mg/ml) [12] or initial computer tomography (CT) findings of fluid collection and longer inflamed colon [13] could be useful factors in selecting patients who could benefit from antibiotic treatment, but these preliminary data need to be confirmed by further studies.…”