QS124 - Oral vs Intravenous Antibiotics Following Discharge After Nonoperative Management of Diverticular Abscess

Purpose/Background: Patients with contained diverticular local perforations with or without abscess are managed with inpatient intravenous antibiotics and interventional radiologic (IR) drainage for abscesses ≥3-4cm. Following symptom resolution and when meeting discharge criteria, patients are discharged on antibiotics. There is no consensus on the need for inpatient Infectious Disease consults and the efficacy of oral versus intravenous antibiotics after discharge. The aim of this study is to determine if oral antibiotics at discharge are as effective as intravenous (IV) antibiotics for this patient population.

Methods/Interventions: This is a retrospective single institution analysis of patients with diverticular local perforations and abscesses on the colorectal surgery service from January 1, 2018 to September 30, 2023. Primary outcome was readmission for recurrent diverticulitis. Secondary outcomes included need for antibiotics refill and need for operation following discharge. Kaplan-Meier curves and cumulative incidence curves were estimated for time to readmission and time to operation after discharge stratified by oral or intravenous antibiotics.

Results/Outcomes: 277 patients met inclusion criteria: 33 discharged on intravenous and 244 discharged on oral antibiotics. The most common organisms cultured from abscesses were E. coli (60.5%) and Streptococcus (58.1%). Infectious Disease (ID) consults were obtained more often for those discharged on IV antibiotics (97.0% vs 3.3%, p< 0.001). Interventional Radiologic (IR) drains were placed in 37.5% of patients in the IV group and 10.3% of those in in oral antibiotic group. Ceftriaxone/metronidazole (48.5%) was the most common IV and cefuroxime/metronidazole (74.1%) was the most common oral antibiotic choice at discharge. There was no significant difference between groups in readmission for recurrent diverticulitis (IV 18.2% vs oral 19.3%, p=0.882) and need for antibiotic refills (IV 9.1% vs oral 6.1%, p=0.52). Those discharged on IV antibiotics required subsequent operative intervention more often than the oral group (63.6% vs 35.2%, p=0.002).

Conclusion/Discussion: Patients admitted with diverticular abscesses and local perforations do not need routine ID consults and may be discharged on oral antibiotics after responding to standard inpatient antibiotics without increased risk for readmissions and without the cost associated with home IV antibiotics.