P0184 - Outpatient Use of Antibiotics in Uncomplicated Diverticulitis Decreases Hospital Admissions

Mark Ayoub, MD¹, Julton Tomanguilo-Chumbe, MD¹, Joel Chittazhattu, DO¹, Frank Annie, PhD², Morgan B. Koontz, MS³, Harleen K. Chela, MD⁴, Ebubekir Daglilar, MD^1
1West Virginia University-Charleston Area Medical Center, Charleston, WV; ²Charleston Area Medical Center, West Virginia State University Charleston Division, Charleston, WV; ³Charleston Area Medical Center, Charleston, WV; ⁴Charleston Area Medical Center/WVU, Charleston, WV

Introduction: Recent studies have been conflicting on the role of antibiotics in the outcomes of patients with diverticulitis showing no significant difference in outcomes with the use of antibiotics and suggesting a conservative approach. The American Gastroenterological Association (AGA) updated its guidelines in 2015 and continues to recommend the use of antibiotics in patients with diverticulitis. Our study highlights their role in the outpatient management of uncomplicated diverticulitis.

Methods: We queried the Diamond Network through TriNetX-Research Network that includes 92 healthcare organizations. Inclusion criteria are; diagnosis of large intestine diverticulitis without perforation, abscess or bleeding. Exclusion criteria included any of sepsis criteria, CRP > 15, immunodeficiency or HIV, coronary artery disease, chronic kidney disease, Crohn’s disease or ulcerative colitis, heart failure, hypertension, or diabetes. Patients with uncomplicated diverticulitis were divided into two cohorts; the first included patients on antibiotics, the second included patients not on any antibiotics. Two well-matched cohorts were made using 1:1 propensity-scored matching model between cohorts. Baseline patients’ characteristics are in Table 1. We compared the rate of hospital or ICU admission and associated complications.

Results: A total of 214,277 patients met the inclusion criteria. Of those, 58.9% (n=126,395) were on antibiotics, and 41% (n=87,882) were not on any. After propensity matching, the study included 84,320 patients on antibiotics vs 84,320 patients not on antibiotics. Hospital admission rate was lower in the antibiotic group (3.3% vs 4.2%, p< 0.001). There was a statistical difference between ICU admission (0.1% and 0.15%, p< 0.01) as well as the rate of bowel perforation, peritonitis, abscess formation or bleeding (1.3% vs 1.4%, p< 0.05). There was no statistical difference in mortality between the two groups (0.1% vs 0.1%, p=0.11), C.diff infection (0.1% vs 0.1%, p=0.9), colectomies (0.2% vs 0.2%, p=0.33), or Acute Kidney Injury (AKI) (0.1% vs 0.1%, p=0.28). See table 2.

Discussion: Outpatient use of antibiotics in patients with acute uncomplicated diverticulitis is associated with lower rates of hospital admissions. It also lowers the rate of bowel perforation, peritonitis, abscess formation, or bleeding in those patients. There is no difference in mortality, AKI, C.diff infection, or surgical intervention. A cost-benefit analysis is needed to see if their regular use should be encouraged.




Disclosures:


Mark Ayoub, MD¹, Julton Tomanguilo-Chumbe, MD¹, Joel Chittazhattu, DO¹, Frank Annie, PhD², Morgan B. Koontz, MS³, Harleen K. Chela, MD⁴, Ebubekir Daglilar, MD¹. P0184 - Outpatient Use of Antibiotics in Uncomplicated Diverticulitis Decreases Hospital Admissions, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.