Department of Gastroenterology, Toyonaka Municipal Hospital, Japan.
Department of Gastroenterology and Internal Medicine, Hayashi Clinic, Japan.
Intern Med. 2022 Dec 1;61(23):3475-3482. doi: 10.2169/internalmedicine.9361-22. Epub 2022 May 7.
Objective Treatment for uncomplicated diverticulitis (UD) is not well established. We evaluated the strategy of reviewing intravenous antibiotics for hospitalized Japanese patients with UD. Methods Treatment was based on the physician's choice until August 2018; the indications for hospitalization and treatment have been standardized since September 2018. In this study, we monitored the use of intravenous antibiotics administered to patients hospitalized for UD and then reviewed the need for them on hospital day 3. We compared patients' length of antibiotic use, hospital stay, health care cost, and complications via the review strategy from September 2018 to December 2020 and via the previous physicians' choice strategy from January 2016 to August 2018. Results Two hundred and forty-seven patients were admitted to our hospital because of acute colonic diverticulitis from January 2016 to December 2020. After excluding complicated cases, 106 individuals were enrolled during the period of physician's choice; 87 were enrolled when treatment review was employed. There were no significant differences in age, sex, inflammation site, or severity during the first hospital visit. The median duration of antibiotic use was significantly reduced from 5 to 4 days (p=0.0075), with no marked increase in rates of transfer to surgery, mortality, or readmission due to recurrence. A more significant proportion of patients completed 3-day antibiotic treatment with the review strategy than with the physician's choice strategy (6.6% vs. 25.3%, p=0.0004). However, the length of hospital stay and total medical costs did not decrease. Conclusion The strategy of reviewing treatment on day 3 after hospitalization for UD safety reduced the duration of antibiotic use, but the hospital stay and health care costs did not decrease.
对于单纯性憩室炎（UD），尚未确立有效的治疗方法。本研究评估了对日本住院治疗 UD 患者静脉应用抗生素的治疗策略。
在 2018 年 8 月前，治疗方案基于医生的选择；2018 年 9 月后，住院指征和治疗方案已标准化。本研究监测了因 UD 住院患者静脉应用抗生素的情况，然后在入院第 3 天评估其继续使用的必要性。我们比较了 2018 年 9 月至 2020 年 12 月采用回顾性策略和 2016 年 1 月至 2018 年 8 月采用医生选择策略的患者抗生素使用时间、住院时间、医疗费用和并发症。
2016 年 1 月至 2020 年 12 月期间，因急性结肠憩室炎我院共收治 247 例患者。排除复杂病例后，医生选择策略期间纳入 106 例，采用治疗回顾策略纳入 87 例。两组患者的年龄、性别、炎症部位和严重程度在首次就诊时无显著差异。与医生选择策略相比，抗生素使用时间从 5 天缩短至 4 天（p=0.0075），但手术转归、死亡率或因复发再次入院的比例没有明显增加。采用回顾性策略的患者中，有 6.6%完成了 3 天抗生素治疗，而采用医生选择策略的患者中完成这一治疗的比例为 25.3%（p=0.0004）。然而，住院时间和总医疗费用没有减少。
对于 UD 患者，在住院第 3 天评估治疗方案可减少抗生素使用时间，但住院时间和医疗费用没有减少。
