CT Scan and Antibiotic Usage Trends for Diverticulitis

TOPLINE:

Despite lower admission rates, the incidence of diverticulitis has increased over 8 years in the United States, along with an increased use of CT scans and a shift to penicillin-based antibiotics, a study found.

METHODOLOGY:

• The researchers conducted a cross-sectional study using data from the Epic Cosmos database of 186,138,130 total ED visits between 2016 and 2023 in the United States.
• The outcomes included the percentage of total ED visits for acute diverticulitis, rates of admissions, use of CT scans, and rates of antibiotic prescriptions for admitted and discharged patients.

TAKEAWAY:

• The incidence of diverticulitis in EDs in the United States increased from 0.4% in 2016 to 0.56% in 2023, with CT imaging performed in 89.6% of cases. CT scan usage increased from 83% to 92.6% over time.
• About 29.8% of patients with diverticulitis required hospital admission, with admission rates declining from 33.6% to 27.7% over time.
• Among the admitted patients, the use of metronidazole and fluoroquinolone declined by 15.3% and 40.7%, respectively; however, the use of third-generation cephalosporins and penicillin-based drugs increased by 14.3% and 19.5%, respectively.
• Among the discharged patients, 90.4% received antibiotics. The use of fluoroquinolone and metronidazole decreased by 45.2% and 39.4%, respectively, whereas the use of amoxicillin-clavulanate increased by 40.3%.

IN PRACTICE:

“Diverticulitis had a gradually rising incidence over time. While admission rates have decreased, CT imaging has become more common. Given that complicated diverticulitis only occurs in approximately 8-12% of cases and most of these remain nonsurgical, it is important to weigh the risks and benefits when opting for CT imaging,” the authors wrote.

SOURCE:

The study was led by Michael Gottlieb, MD, Rush University Medical Center, Chicago, and was published online on October 5, 2024, in The American Journal of Emergency Medicine.

LIMITATIONS:

The Cosmos database may not fully capture all cases of diverticulitis seen in EDs, as cases might be missed due to coding errors, limited data on other diagnoses requiring CT imaging or admission, and the inability to distinguish between uncomplicated and complicated diverticulitis.

DISCLOSURES:

The study did not receive any external funding. No conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.