[Tratamiento ambulatorio de la diverticulitis aguda no complicada. Análisis de nuestra experiencia]. / Outpatient treatment of uncomplicated acute diverticulitis. Analysis of our experience.

OBJECTIVE: Analyze the safety and efficacy of the outpatient treatment of uncomplicated acute diverticulitis and a costs analysis. METHOD: We conducted a prospective, non-randomized study between June 2014 and June 2017. We included all patients diagnosed of uncomplicated acute diverticulitis based on clinical and abdominal computed tomography scan in the Emergency Department of the University Hospital San Juan de Alicante (Spain). Outpatient treatment consisted of oral antibiotics for 7 days (amoxicillin-clavulanate or ciprofloxacin and metronidazole in patients with betalactamic allergy), liquid diet for 72 h and analgesics. Costs were evaluated according to the Law of Rates of Valencian Community. RESULTS: Ninety patients were included, 49 females and 41 males with a median age of 56 years. Success rate was 95.5% (n = 86) requiring hospital admission 4 patients (4.5%). Antibiotic treatment was amoxicillin-clavulanate in 82 patients (91.1%) and ciprofloxacin and metronidazole in 8 (8.9%). Cost savings per patient was approximately 1985 € comparing with hypothetically all inpatient treatment. CONCLUSIONS: Outpatient treatment of uncomplicated acute diverticulitis can be performed successfully in most patients allowing an important cost savings.

OBJETIVO: Evaluar la seguridad y la eficacia del tratamiento con antibiótico oral para la diverticulitis aguda no complicada, y realizar un análisis de costos. MÉTODO: Estudio prospectivo, no aleatorizado, entre junio de 2014 y junio de 2017. Se incluyeron todos los pacientes diagnosticados de diverticulitis aguda no complicada según la clínica y la tomografía abdominal en el servicio de urgencias del Hospital Universitario San Juan de Alicante (España). El tratamiento ambulatorio consistió en antibiótico oral durante 7 días (amoxicilina-ácido clavulánico o ciprofloxacino y metronidazol en alérgicos a los betalactámicos), dieta líquida durante 72 horas y analgésicos. Los costos fueron evaluados según la Ley de Tasas de la Comunidad Valenciana. RESULTADOS: Se incluyeron 90 pacientes, 49 mujeres y 41 hombres, con una mediana de edad de 56 años. La tasa de éxito fue del 95.5% (n = 86), necesitando ingreso hospitalario cuatro pacientes (4.5%). El tratamiento antibiótico empleado fue amoxicilina-ácido clavulánico en 82 pacientes (91.1%) y ciprofloxacino con metronidazol en ocho pacientes (8.9%). El ahorro por paciente fue de 1985 euros en comparación con el hipotético ingreso de todos los pacientes. CONCLUSIONES: El tratamiento ambulatorio de la diverticulitis aguda no complicada se completó con éxito en la mayoría de los pacientes, permitiendo una importante reducción del gasto.

Hernia inguinal tubo-ovárica incarcerada / Incarcerated tuboovarian inguinal hernia

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Microbiologic Analysis of Complicated and Uncomplicated Acute Appendicitis.

BACKGROUND: Microbiologic studies suggest that complicated (CAA) and uncomplicated (UAA) acute appendicitis are different entities. Routine peritoneal fluid cultures continue to be controversially related to a low positive rate, found mainly in UAA; to isolation of typical micro-organisms with expected susceptibilities; and to a community-acquired intra-abdominal infection. The aim of this study was to describe microbiologic isolates in CAA and UAA and the usefulness of peritoneal fluid cultures to determine the susceptibilities to our antibiotic therapy guidelines. METHODS: This study was a retrospective review of a prospective database collected at University San Juan Hospital (Spain) between June 2014 and June 2017. Complicated acute appendicitis was defined as gangrenous or perforated, whereas UAA was defined as phegmonous or suppurative. Our antibiotic recommendations are amoxicillin-clavulanic acid and in patients with ß-lactam allergies, metronidazole plus aztreonam, and an aminoglycoside (gentamicin or tobramycin). Microbiologic cultures were performed in 264 patients, 157 with a CAA and 107 with a UAA. RESULTS: The positive culture rate was significantly higher in CAA (59%) than in UAA (24.3%). Gram-positive cocci (51.6% CAA; 23.1% UAA), including Streptococcus constellatus (29% CAA; 3.8% UAA), and anaerobes (67.7% CAA; 42.3% UAA) were significantly more common in CAA. The rates of antibiotic resistance were amoxicillin-clavulanic acid 14% (17.2% CAA; 3.8% UAA), gentamicin or tobramycin 8.4% (9.7% CAA; 3.8% UAA), ciprofloxacin 5.9% (6.5% CAA; 3.8% UAA), and ertapenem 10.9% (14% CAA; 0 UAA). CONCLUSIONS: The culture-positive rate was higher in CAA, with different isolates and susceptibilities than in UAA, identifying a higher frequency of gram-positive cocci (including S. constellatus) and anaerobes. We recommend obtaining peritoneal fluid cultures in CAA, which frequently will lead to a change in the antimicrobial drug therapy guidelines, creating specific recommendations in AA.