Shaya J. Noorian, MD1, Olga Aroniadis, MD, MSc2, Paul Feuerstadt, MD, FACG3, Joann Kwah, MD, FACG2
1Albert Einstein College of Medicine, Beverly Hills, CA; 2Montefiore Medical Center, Bronx, NY; 3Yale New Haven Hospital, Hamden, CT
Introduction: In 2015, the ACG introduced a clinical guideline defining colon ischemia (CI) severity (mild, moderate, or severe) and recommending administration of antibiotics in those with moderate and severe CI. The goal of our study was to assess for differences in guideline-adherent antimicrobial use pre- and post- guideline publication.
Methods: A database of consecutive patients diagnosed with biopsy-proven CI at Montefiore Medical Center and Yale-New Haven Hospital was utilized. Patients admitted from 2012-2014 (CI 12-14) and 2015-2017 (CI 15-17) composed the pre- and post- guideline cohorts, respectively. Our primary outcome was the frequency of guideline-recommended antibiotic use, defined as: (i) metronidazole+(ciprofloxacin or cephalosporin) or (ii) piperacillin-tazobactam in patients with moderate or severe CI. Secondary outcomes included overall antibiotic use for CI, individual antibiotic type and clinical outcomes (ICU requirement, length of stay, readmission, recurrence, mortality, and colectomy rates).
Results: The CI 12-14 (n=169) and CI 15-17 (n=84) cohorts were similar in background characteristics: mean age (68.2 vs. 69.5 yrs; p=0.47), female sex (65.1% vs. 76.2%; p=0.07), and Charlson comborbidity score (5.3 vs. 5.1; p=0.65). CI severity was similar between cohorts: mild (1.2% vs. 0.0%; p=0.55), moderate (41.4% vs. 47.6%; p=0.35) and severe (57.4% vs. 52.4%; p=0.65). A trend for increased guideline-recommended antibiotic use was observed from CI 12-14 to CI 15-17 (50.3% vs. 58.3%; p=0.23) (Fig.1). A non-significant increase was observed in overall antibiotic use (69.8% vs. 77.4%; p=0.21). Ciprofloxacin use decreased from CI 12-14 to CI 15-17 (61.0% vs. 44.6%; p=0.03), but no significant differences were observed for other antibiotic types (Fig.2). The 30-day mortality (1.3% vs. 8.0%; p=0.01) and 30-day mortality and/or colectomy rates (6.0% vs. 16.0%; p=0.01) increased from CI 12-14 to CI 15-17. Non-significant differences were observed for other clinical outcomes (Fig.3).
Discussion: The trend of increased antibiotic use post-guideline publication may have been a result of the new recommendations or the treatment of acutely sicker patients experiencing worse clinical outcomes. The decrease in ciprofloxacin use follows a nationwide trend and may be due to antimicrobial stewardship efforts to minimize the risk of C. difficile infection. Further research is needed to better understand the indications for antimicrobial use in the post-guideline era and worsened outcomes.
Citation: Shaya J. Noorian, MD; Olga Aroniadis, MD, MSc; Paul Feuerstadt, MD, FACG; Joann Kwah, MD, FACG. P0120 - CHANGES IN ANTIBIOTIC USAGE PATTERNS FOR TREATMENT OF COLON ISCHEMIA SINCE ACG GUIDELINE RECOMMENDATIONS. Program No. P0120. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.