J Gastroenterol Hepatol Endosc | Volume 6, Issue 1 | Research Article | Open Access

Patterns of Antibiotic Use for the Treatment of Colon Ischemia Before and After Guideline Publication: Has Anything Changed?

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

*Correspondance to: Shaya Noorian 

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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..

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