Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone.

Détails

ID Serval
serval:BIB_50A56F284A7E
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Antibiotic treatment for uncomplicated and mild complicated diverticulitis: outpatient treatment for everyone.
Périodique
International journal of colorectal disease
Auteur(s)
Joliat G.R., Emery J., Demartines N., Hübner M., Yersin B., Hahnloser D.
ISSN
1432-1262 (Electronic)
ISSN-L
0179-1958
Statut éditorial
Publié
Date de publication
09/2017
Peer-reviewed
Oui
Volume
32
Numéro
9
Pages
1313-1319
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article
Publication Status: ppublish
Résumé
Antibiotic treatment is the treatment of choice for uncomplicated diverticulitis (uD) and can be performed for mild complicated diverticulitis (mcD). In several cases, outpatient treatment (OT) can be undertaken. This study assessed the 1-month failure rate of OT for uD/mcD compared to inpatient treatment (IT), and identified predictive factors for treatment failure.
All consecutive patients (2006-2012) diagnosed with uD/mcD by CT scan were retrospectively analyzed. Acute uD was defined as absence of the following: abscess, fistula, extraluminal contrast, pneumoperitoneum, and need for immediate percutaneous drainage/surgery. Acute mcD was defined as complicated diverticulitis with abscess <4 cm or pneumoperitoneum <2 cm. All patients received antibiotherapy. Treatment failure was defined as (re)hospitalization the first month after treatment onset or need of drainage/surgery during hospitalization. All patients were contacted using a standardized questionnaire.
Out of 540 uD/mcD, IT was offered to 369 patients (68%) and OT to 171 patients (32%). The IT group had higher median age, more women, higher median Charlson Index, more severe median Ambrosetti score, longer median time in the emergency room, and higher median CRP. Response rates to the questionnaire were 56% (IT) vs. 62% (OT), p = 0.18. Failure rates were 32% in IT vs. 10% in OT group, p < 0.01. Among the uD/mcD patients, admission/CT time between midnight and 6 AM, Ambrosetti score of 4, and free air around the colon were risk factors for failure.
Outpatient treatment for uncomplicated/mild complicated diverticulitis is feasible and safe. Prognostic factors of failure necessitating closer follow-up were admission/CT time, Ambrosetti score of 4, and free air around the colon.
Mots-clé
Adult, Aged, Ambulatory Care, Anti-Bacterial Agents/adverse effects, Anti-Bacterial Agents/therapeutic use, Colectomy, Colonoscopy, Diverticulitis, Colonic/complications, Diverticulitis, Colonic/diagnostic imaging, Diverticulitis, Colonic/drug therapy, Drainage, Female, Humans, Inpatients, Male, Middle Aged, Patient Admission, Retrospective Studies, Risk Factors, Time Factors, Tomography, X-Ray Computed, Treatment Failure, Antibiotics, Diverticulitis, Outpatient treatment, Treatment failure
Pubmed
Web of science
Création de la notice
28/07/2017 14:02
Dernière modification de la notice
06/08/2018 18:07
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