Optimizing antibiotic use in diverticulitis: an antimicrobial stewardship audit for targeted improvement
Daniel Zhang, Mark R. Armstrong, Paul M. Griffin, Ian GassiepAbstract
Purpose:
Diverticulitis is a common indication for inpatient antibiotic therapy. Therapeutic Guidelines (eTG) are available to inform practice, but uncertainty remains over rates of adherence to guidelines and outcomes related to antibiotic choice. The authors aimed to assess the degree of compliance to local prescribing guidelines and associated outcomes for inpatients with acute diverticulitis.
Methods:
Patients admitted to the Mater Hospital Brisbane between January 2019 and December 2023 with proven diverticulitis were included. Clinical, biochemical, treatment, and 90-day outcome data were assessed. Key clinical outcomes and prescribing practices were compared in relation to compliance.
Results:
A total of 445 patients comprising 155 (35%) with complicated and 290 (65%) with uncomplicated diverticulitis were included. Overall guideline compliance was 252/445 (57%) and was lower for complicated 55/155 (35%) compared with uncomplicated diverticulitis 197/290 (68%), P < 0.01. In multivariable analysis, complicated diverticulitis at presentation was the only significant variable associated with non-compliance, aOR: 2.73 (95% CI: 1.68–4.46, P < .001). Non-compliant prescriptions were also associated with a longer course of intravenous therapy, median 5 (IQR: 3–7) vs 3 (IQR: 2–5) days, P < .001. There were no associations with adverse outcomes in relation to compliance.
Conclusion:
The overall adherence to antimicrobial prescribing guidelines for management of diverticulitis was poor. Clinicians were most likely to prescribe non-compliantly for patients presenting with complicated diverticulitis. However, compliance was not associated with adverse outcomes. This suggests guideline-compliance is safe and there is limited benefit of broad-spectrum therapy, with potentially increased adverse effects.