Division of Gastroenterology and Hepatology, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Department of Gastroenterology and Hepatology, University of California San Francisco Fresno and VA Medical Center Fresno, Fresno, California.
Dis Colon Rectum. 2019 Aug;62(8):1005-1012. doi: 10.1097/DCR.0000000000001324.
Antibiotics are routinely used for diverticulitis irrespective of severity. Current practice guidelines favor against the use of antibiotics for acute uncomplicated diverticulitis.
We performed a systematic review and meta-analysis to examine the role of antibiotic use in an episode of uncomplicated diverticulitis.
PubMed/Medline, Embase, Scopus, and Cochrane were used.
Eligible studies included those with patients with uncomplicated diverticulitis receiving any antibiotics compared with patients not receiving any antibiotics (or observed alone).
Pooled odds rate of total complications, treatment failure, recurrent diverticulitis, readmission rate, sigmoid resection, mortality rate, and length of stay were measured.
Of 1050 citations reviewed, 7 studies were eligible for the analysis. There were total of 2241 patients: 895 received antibiotics (mean age = 59.1 y; 38% men) and 1346 did not receive antibiotics (mean age = 59.4 y; 37% men). Antibiotics were later added in 2.7% patients who initially were observed off antibiotics. Length of hospital stay was not significantly different among either group (no antibiotics = 3.1 d vs antibiotics = 4.5 d; p = 0.20). Pooled rate of recurrent diverticulitis was not significantly different among both groups (pooled OR = 1.27 (95%, CI 0.90-1.79); p = 0.18). Rate of total complications (pooled OR = 1.99 (95% CI, 0.66-6.01); p = 0.22), treatment failure (pooled OR = 0.68 (95% CI, 0.42-1.09); p = 0.11), readmissions (pooled OR = 0.75 (95% CI, 0.44-1.30); p = 0.31). and patients who required sigmoid resection (pooled OR = 3.37 (95% CI, 0.65-17.34); p = 0.15) were not significantly different among patients who received antibiotics and those who did not. Mortality rates were 4 of 1310 (no-antibiotic group) versus 4 of 863 (antibiotic group).
Only 2 randomized controlled studies were available and there was high heterogeneity in existing data.
This meta-analysis of current literature shows that patients with uncomplicated diverticulitis can be monitored off antibiotics.
抗生素常规用于憩室炎，无论严重程度如何。目前的临床实践指南不建议使用抗生素治疗急性单纯性憩室炎。
我们进行了一项系统评价和荟萃分析，以研究抗生素在单纯性憩室炎发作中的作用。
使用 PubMed/Medline、Embase、Scopus 和 Cochrane。
纳入接受任何抗生素治疗与未接受抗生素治疗（或单独观察）的单纯性憩室炎患者的研究。
总并发症、治疗失败、复发性憩室炎、再入院率、乙状结肠切除术、死亡率和住院时间的汇总优势比。
在审查的 1050 篇引文中有 7 项研究符合分析要求。共有 2241 例患者入组：895 例接受抗生素治疗（平均年龄=59.1 岁；38%为男性），1346 例未接受抗生素治疗（平均年龄=59.4 岁；37%为男性）。有 2.7%的初始未接受抗生素治疗的患者后来加用了抗生素。两组的住院时间无显著差异（无抗生素组=3.1 天 vs 抗生素组=4.5 天；p=0.20）。两组的复发性憩室炎发生率无显著差异（汇总优势比=1.27（95%CI，0.90-1.79）；p=0.18）。总并发症发生率（汇总优势比=1.99（95%CI，0.66-6.01）；p=0.22）、治疗失败率（汇总优势比=0.68（95%CI，0.42-1.09）；p=0.11）、再入院率（汇总优势比=0.75（95%CI，0.44-1.30）；p=0.31）和需要乙状结肠切除术的患者比例（汇总优势比=3.37（95%CI，0.65-17.34）；p=0.15）在接受抗生素治疗和未接受抗生素治疗的患者之间无显著差异。抗生素组 863 例患者中有 4 例死亡，非抗生素组 1310 例患者中有 4 例死亡。
仅有 2 项随机对照研究可用，且现有数据存在高度异质性。
对当前文献的荟萃分析表明，单纯性憩室炎患者可以在不使用抗生素的情况下接受监测。
