单纯性急性憩室炎中抗生素的长期作用。

Long-Term Effects of Omitting Antibiotics in Uncomplicated Acute Diverticulitis.

机构信息

Department of Surgery, Academic Medical Center, Amsterdam, Netherlands. Department of Surgery, Westfries Gasthuis, Hoorn, Netherlands. Medical Centre Alkmaar, Alkmaar, Netherlands. Spaarne Gasthuis, Haarlem and Hoofddorp, Netherlands. Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. OLVG, Amsterdam, Netherlands. Meander Medical Centre, Hoogland, Amersfoort, Netherlands. Albert Schweitzer Hospital, Dordrecht, Netherlands. Ziekenhuisgroep Twente Hospital, Almelo, Netherlands.

出版信息

Am J Gastroenterol. 2018 Jul;113(7):1045-1052. doi: 10.1038/s41395-018-0030-y. Epub 2018 May 11.

DOI:10.1038/s41395-018-0030-y

PMID:29700480

Abstract

BACKGROUND

Traditionally uncomplicated acute diverticulitis was routinely treated with antibiotics, although evidence for this strategy was lacking. Recently, two randomized clinical trials (AVOD trial and DIABOLO trial) published short-term results of omitting antibiotics compared to routine antibiotic treatment. Both showed no significant differences regarding recovery from the initial episode, as well as rates of complicated or recurrent diverticulitis and sigmoid resection. However, both studies showed a trend of higher rates of sigmoid resection in the observational groups. Here, the long-term effects of omitting antibiotics in first episode uncomplicated acute diverticulitis were assessed.

METHODS

A total of 528 patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomized to either an observational or an antibiotic treatment strategy (DIABOLO trial). Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months' follow up. Differences between the groups were explored and risk factors were identified using multivariable logistic regression.

RESULTS

Complete case analyses showed no difference in rates of recurrent diverticulitis (15.4% in the observational group versus 14.9% in the antibiotic group; p = 0.885), complicated diverticulitis (4.8% versus 3.3%; p = 0.403) and sigmoid resection (9.0% versus. 5.0%; p = 0.085). Young patients (<50 years) and patients with a pain score at presentation of 8 or higher on a visual analogue pain scale were at risk for complicated or recurrent diverticulitis. In this multivariable analysis, treatment type (with or without antibiotics) was not an independent predictor for complicated or recurrent diverticulitis.

CONCLUSION

Omitting antibiotics in the treatment of uncomplicated acute diverticulitis did not result in more complicated diverticulitis, recurrent diverticulitis or sigmoid resections at long-term follow up. As the DIABOLO trial was not powered for these secondary outcome measures, some uncertainty remains whether (small) non-significant differences could be true associations.

摘要

背景

传统上，单纯性急性憩室炎通常采用抗生素治疗，尽管缺乏这种策略的证据。最近，两项随机临床试验（AVOD 试验和 DIABOLO 试验）发表了与常规抗生素治疗相比，省略抗生素的短期结果。两者均显示在初始发作的恢复以及复杂或复发性憩室炎和乙状结肠切除术的发生率方面均无显著差异。然而，这两项研究都显示出观察组中乙状结肠切除术的比例较高的趋势。在这里，评估了在首次发作的单纯性急性憩室炎中省略抗生素的长期效果。

方法

共有 528 名 CT 证实的原发性左侧单纯性急性憩室炎患者被随机分为观察组或抗生素治疗组（DIABOLO 试验）。主要终点为 24 个月随访时的复杂憩室炎、复发性憩室炎和乙状结肠切除术。使用多变量逻辑回归探索组间差异并确定危险因素。

结果

完全案例分析显示，复发性憩室炎的发生率无差异（观察组为 15.4%，抗生素组为 14.9%；p=0.885），复杂憩室炎的发生率（4.8%对 3.3%；p=0.403）和乙状结肠切除术（9.0%对 5.0%；p=0.085）。年轻患者（<50 岁）和就诊时视觉模拟疼痛量表上的疼痛评分≥8 的患者存在发生复杂或复发性憩室炎的风险。在这项多变量分析中，治疗类型（用或不用抗生素）不是复杂或复发性憩室炎的独立预测因素。