EP219 - How Much More Do You Need? Outcome Variability with Antibiotic Duration in Patients Admitted for Acute Diverticulitis

Sunday, May 11, 2025

8:54 AM – 8:59 AM PT

Location: Monitor 2, Sails Pavilion, Upper Level

ePoster Presenter(s)

Olivia Ziegler, MD

General Surgery Resident
Penn State Milton S. Hershey Medical Center - Hershey, PA
Penn State Milton S Hershey Medical Center
Hershey, PA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

AG

Alicia C. Greene, DO

General Surgery Resident
Penn State Milton S Hershey Medical Center
Herhsey, Pennsylvania, United States

Disclosure information not submitted.
ES

Eric W. Schaefer, MS

Biostatistician
The Pennsylvania State University, Penn State College of Medicine, Department of Public Health Sciences
Herhsey, Pennsylvania, United States

Disclosure information not submitted.
ZD

Zachary Delgado, MD

General Surgery Resident
Penn State Milton S Hershey Medical Center
Herhsey, Pennsylvania, United States

Disclosure information not submitted.
LC

Laura E. Cooper, MD

Fellow
Penn State Milton S. Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
PL

Patricio B. Lynn, MD

Assistant Professor of Surgery
Penn State Milton S. Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.
MD

Michael J. Deutsch, MD

Associate Professor
Penn State Milton S Hershey Medical Center, Division of Colon and Rectal Surgery
Herhsey, Pennsylvania, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JS

Jeffrey S. Scow, MD

Associate Professor of Surgery
Penn State Milton S. Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.

Senior Author(s)

AK

Audrey S. Kulaylat, MD, MSc

Assistant Professor of Surgery
Penn State Milton S Hershey Medical Center, Division of Colon and Rectal Surgery
Hershey, Pennsylvania, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Olivia Ziegler, MD: This individual has no financial relationships with ineligible companies.

Laura E. Cooper, MD: This individual has no financial relationships with ineligible companies.

Michael J. Deutsch, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: The ideal duration of antibiotics for diverticulitis managed without upfront surgery is unknown, particularly in those with diverticulitis severe enough to warrant admission. Here, we assess outcomes stratified by post-discharge antibiotic duration in patients admitted for management of diverticulitis without upfront surgery.

Methods/Interventions: MarketScan® database (2016-2022) was employed to identify patients over 18 who had inpatient admission associated with an ICD-10 code indicating diverticulitis. Patients who had a diverticular fistula, were admitted longer than 30 days, or did not fill a prescription within three days of discharge were excluded.

Antibiotic durations were compared for 90-day outcomes of interest including diverticulitis-related readmission, emergency department (ED) visits, additional antibiotic prescriptions, and surgery. Outcomes were assessed using chi square and logistic regression, adjusting for baseline characteristics and length of admission.

Results/Outcomes: 22,029 patients met inclusion criteria, 47.8% were female with a median age of 53 years. Median duration of prescription was 10 days.

In unadjusted analysis, compared to those with antibiotic prescriptions ranging from 7 to 11 or more days, those with prescription durations of < 7 days had lower rates of surgery (7.8% vs 8.3-13.6%, p< 0.001), diverticulitis-related readmission (12.3% vs 12.8-18.6%, p< 0.001) and ED visits (9% vs 9-10.8%, p=0.020), and subsequent antibiotic prescriptions (37.7% vs 37.7-42.2%, p< 0.001) (fig 1).

In an adjusted model, longer durations of antibiotic prescriptions were associated with increased odds of surgery compared to those with prescriptions lasting 7 days (10 days: OR=1.27(1.13-1.43), p< 0.001; 11 or more days: 1.46(1.29-1.66), p< 0.001), while courses < 7 days were associated with decreased odds of surgery (OR=0.77(0.66-0.90), p=0.001).

Similarly, longer antibiotic courses were associated with increased odds of diverticulitis related re-admission (10 days: OR=1.17(1.06-1.30), p=0.001; 11 or more days: 1.35(1.21-1.50), p< 0.001), while courses < 7 days were associated with significantly decreased odds of readmission (OR=0.80(0.70-0.91), p=0.001).

Increased odds of diverticulitis related readmission were only associated with prescriptions of 11 or more days (1.17(1.03-1.33), p=0.019). While odds of additional antibiotic prescriptions again increased with prescriptions of 11 or more days (1.14(1.05-1.24), p=0.001) and decreased with prescriptions lasting < 7 days (0.90(0.83-0.99), p=0.027).

Conclusion/Discussion: Longer post-discharge antibiotic treatment durations are associated with increased odds of treatment failure and may indicate more severe disease rather than reducing further treatments. More standardized guidelines are needed to avoid overuse of antibiotics, particularly if they are not beneficial in reducing early recurrence of disease. In either case, patients may benefit from earlier surgical consultation given their apparent increased risk of recrudescent disease and surgery.