Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

作     者：Danial Haris Shaikh Harish Patel Rezwan Munshi Haozhe Sun Shehriyar Mehershahi Ahmed Baiomi Ahmed Alemam Usman Pirzada Iqra Nawaz Kamrun Naher Siddarth Hanumanthu Suresh Nayudu 

作者机构：Division of GastroenterologyDepartment of MedicineBronxCare Health SystemBronxNY 10457United States Department of MedicineNassau University Medical CenterNew YorkNY 11554United States Department of MedicineBronxCare Health SystemBronxNY 10457United States 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2021年第13卷第11期

页      面：1436-1447页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Appendectomy Clostridium difficile Toxic megacolon Colectomy Gut microbiome 

摘      要：BACKGROUND Clostridium difficile infection(CDI)occurs due to a dysbiosis in the *** appendix is considered a‘safe house’for gut microbiota and may help repopulate gut flora of patients with *** To study the impact of prior appendectomy on the severity and outcomes of *** We retrospectively reviewed data of 1580 patients with CDI,admitted to our hospital between 2008 to *** were grouped based on the presence or absence of the *** primary aim was to(1)assess all-cause mortality and(2)the severity of *** was defined as per the Infectious Diseases Society of America *** regression,and propensity score analysis using inverse probability of treatment weights(IPTW)was *** Of the 1580 patients,12.5%had a history of *** was no statistical difference in mortality between patients with a prior appendectomy or without(13.7%vs 14%,P=0.877).However,a history of appendectomy affected the severity of CDI[odds ratio(OR)=1.32,95%confidence interval:1.01-1.75].On IPTW,this association remained significant(OR=1.59,P0.05).On multivariable toxic megacolon(OR=5.37,P0.05)and colectomy(OR=2.77,P0.05).CONCLUSION Prior appendectomy may affect the severity of CDI,development of toxic megacolon and the eventual need for *** treatment of CDI is governed by its severity,stronger antibiotic regimens or earlier use of fecal microbiota transplant may be a viable option for patients with prior appendectomy.