Shaya Noorian1,2*, Joann Kwah1, Olga Aroniadis1,3, Paul Feuerstadt4and Lawrence J Brandt1
1Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, USA
2Department of Medicine, UCLA Medical Center, USA
3Department of Gastroenterology and Hepatology, Renaissance School of Medicine at Stony Brook University, USA
4Department of Medicine, Yale University School of Medicine, USA
Objective:To determine whether there was a difference in guideline-recommended antibiotic use in the three years following, compared to the three years preceding, release of the 2015 American College of Gastroenterology (ACG) Clinical Guideline on Colon Ischemia (CI).
Patients and Methods:This study included 253 patients diagnosed with CI from January 01st, 2012 through December 31st, 2014 (CI12-14) and January 01st, 2015 through December 31st, 2017 (CI15-17) at Montefiore Medical Center and Yale-New Haven Hospital. The primary outcome was guidelinerecommended antibiotic use: For mild CI, no antibiotics; for moderate-severe CI, either: (i) metronidazole + ciprofloxacin or cephalosporin (ii) piperacillin-tazobactam. Secondary outcomes were specific antibiotic use, overall antibiotic use (irrespective of guideline adherence), and clinical outcomes.
Results:Guideline-recommended antibiotic use was similar in CI12-14and CI15-17(58.3% vs.50.3%, P=0.23). Overall antibiotic use also was similar between CI12-14 and CI15-17 (77.4% vs. 69.8%, P=0.21). Ciprofloxacin use decreased in CI15-17 compared with CI12-14 (44.6% vs. 61.0%, P=0.03). CI15-17experienced higher 30-day mortality (8.0% vs.1.3%, P=0.01) and 30-day mortality or colectomy rates (16.0% vs.6.0%, P=0.01) compared with CI12-14. The remaining outcomes were similar between groups.
Conclusion: Guideline adherence was unchanged post-guideline publication with a significant (>40%) remaining deficit in guideline-recommended antibiotic use. The decrease in ciprofloxacin use follows a nationwide trend and may be attributed to antimicrobial stewardship efforts to minimize the risk of Clostridioides difficileinfection. Further research is needed to explain worsened outcomes post-guideline release, and the impact of specific antimicrobials on outcomes.
Noorian S, Kwah J, Aroniadis O, Feuerstadt P, Brandt LJ. Patterns of Antibiotic Use for the Treatment of Colon Ischemia Before and After Guideline Publication: Has Anything Changed?. J Gastroenterol Hepatol Endosc. 2021; 6(1): 1092..