Hjern Fredrik, Josephson Thomas, Altman Daniel, Holmström Bo, Mellgren Anders, Pollack Johan, Johansson Claes
Division of Surgery, Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
Scand J Gastroenterol. 2007 Jan;42(1):41-7. doi: 10.1080/00365520600780650.
Most patients admitted for acute colonic diverticulitis (AD) are managed conservatively and receive antibiotics, although it is uncertain whether all patients with AD benefit from this treatment. The aim of this study was to evaluate the influence of antibiotic treatment on outcome in the conservative management of patients with mild AD.
A retrospective audit of 311 patients (64% F, mean age 60 years) hospitalized for AD was carried out. All patients were initially treated conservatively with observation and restriction of oral intake. Patients receiving antibiotics (n=118) were compared with patients treated with observation and restriction of oral intake only (n=193). Mean follow-up time (FU) was 30 months.
Inflammation in patients treated with antibiotics was more pronounced (laboratory parameters (C-reactive protein, white blood cell count) were higher (p<0.01), fever was more common (p<0.01) and CT grading of inflammation was classified as severe in a higher proportion (p<0.01)) compared with patients treated without antibiotics. When initially treated with antibiotics, 3 patients (3%) failed to respond to treatment and had to undergo surgery. There were 7 (4%) failures in patients initially treated without antibiotics, and antibiotics were then added. During FU, 29% of patients treated with antibiotics had further events (recurrent AD and/or subsequent surgery) compared with 28% (NS) among those treated without antibiotics. In a multivariate analysis, the risk of a further event was not influenced by antibiotic treatment (OR 1.03, CI 95% 0.61-1.74).
Our results indicate that antibiotics are not mandatory in mild AD. Treatment without antibiotics appears to be safe and seems not to change the rate of further events. These results warrant further randomized prospective studies.
大多数因急性结肠憩室炎（AD）入院的患者接受保守治疗并使用抗生素，尽管尚不确定所有AD患者是否都能从这种治疗中获益。本研究的目的是评估抗生素治疗对轻度AD患者保守治疗结局的影响。
对311例因AD住院的患者（64%为女性，平均年龄60岁）进行了回顾性审计。所有患者最初均接受保守治疗，包括观察和限制经口摄入。将接受抗生素治疗的患者（n=118）与仅接受观察和限制经口摄入治疗的患者（n=193）进行比较。平均随访时间（FU）为30个月。
与未使用抗生素治疗的患者相比，使用抗生素治疗的患者炎症更明显（实验室参数（C反应蛋白、白细胞计数）更高（p<0.01），发热更常见（p<0.01），炎症的CT分级为重度的比例更高（p<0.01））。最初使用抗生素治疗时，3例患者（3%）治疗无效，不得不接受手术。最初未使用抗生素治疗的患者中有7例（4%）治疗失败，随后添加了抗生素。在随访期间，使用抗生素治疗的患者中有29%发生了进一步事件（复发性AD和/或随后的手术），而未使用抗生素治疗的患者中这一比例为28%（无显著性差异）。在多变量分析中，进一步事件的风险不受抗生素治疗的影响（比值比1.03，95%置信区间0.61-1.74）。
我们的结果表明，轻度AD患者并非必须使用抗生素。不使用抗生素的治疗似乎是安全的，且似乎不会改变进一步事件的发生率。这些结果值得进一步开展随机前瞻性研究。
