• Clostridioides difficile
• Cancer
• Epidemiology
• Real World Evidence
• Recurrence
• Risk factors

• Humans
• Clostridioides difficile
• Cohort Studies
• Sweden/epidemiology
• Risk Factors
• Recurrence
• Neoplasms/epidemiology
• Neoplasms/complications
• Clostridium Infections/diagnosis
• Retrospective Studies

• 2020-01058 Vetenskapsrådet
• Ferring Pharmaceuticals
• Karolinska Institute

• Alzheimer’s disease
• Huntington’s disease
• Parkinson’s disease
• autism
• microbiome
• mucosal immunity
• multiple sclerosis
• myalgic encephalomyelitis
• sIgA

• Humans
• Immunity, Mucosal
• Gastrointestinal Microbiome/physiology
• Enteric Nervous System/physiology
• Parkinson Disease
• Brain/physiology

• R01 NS105783 NINDS NIH HHS
• U54 GM104944 NIGMS NIH HHS

Clostridium difficile infection (CDI) occurs due to a dysbiosis in the colon. The appendix is considered a ‘safe house’ for gut microbiota and may help repopulate gut flora of patients with CDI.

To study the impact of prior appendectomy on the severity and outcomes of CDI.

We retrospectively reviewed data of 1580 patients with CDI, admitted to our hospital between 2008 to 2018. Patients were grouped based on the presence or absence of the appendix. The primary aim was to (1) assess all-cause mortality and (2) the severity of CDI. Severity was defined as per the Infectious Diseases Society of America criteria. Logistic regression, and propensity score analysis using inverse probability of treatment weights (IPTW) was performed.

Of the 1580 patients, 12.5% had a history of appendectomy. There 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, P < 0.05). On multivariable analysis of secondary outcomes, prior appendectomy was also associated with toxic megacolon (OR = 5.37, P < 0.05) and colectomy (OR = 2.77, P < 0.05).

Prior appendectomy may affect the severity of CDI, development of toxic megacolon and the eventual need for colectomy. Since 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.

• Appendectomy
• Clostridium difficile
• Toxic megacolon
• Colectomy
• Gut microbiome

• Appendectomy
• Clostridium difficile infection
• Colorectal cancer
• Inflammatory disease
• Sepsis

This literature review assesses how the vermiform appendix has been considered a vestigial organ by many, but over the years, new research has allowed us to reconsider its potential purpose. Studies have indicated that the appendix plays an evident role in immune response and harbors a biofilm that may remain unaffected by gastrointestinal infections, such as infection with Clostridium difficile. Our research analyzes the prominent gut-associated lymphoid tissue (GALT) as a mechanism of defence in infection, as well as the robust biofilm that could aid in the reinoculation of beneficial bacteria within the colon. Furthermore, we wanted to determine if patients who have undergone a prior appendectomy, leading to decreased GALT and a lack of a bacterial reservoir, were predisposed to the development of Clostridium difficile, with particular emphasis in the recurrence and development of fulminant Clostridium difficile infections. Although research continues to be conflicting, there appears to be some connection between these variables, but prospective studies are needed in order to say for certain that there is a link.

• appendectomy
• appendix
• biofilm
• c.diff
• c.difficile
• clostridium difficile
• fulminant
• gut-associated lymphoid tissue
• infection
• recurrent

• Appendix
• Bacteroidetes
• Colitis
• Inflammatory bowel disease
• Microbiome
• Proteobacteria
• Stool
• Winnie

Clostridium difficile infection (CDI) is a gradually emerging healthcare problem in the western world, occurring predominantly from the de-arrangement of the gut microbiota and the widespread use of antibiotics. Recently, it has been proposed that the presence or absence of the appendix could be a factor influencing the occurrence and/or the severity of CDI. We performed a review of the literature, aiming to identify and interpret in an accumulative way the results of the published clinical studies which addressed the issue of a possible association between prior appendicectomy and the features of CDI. A total of five suitable studies were retrieved, which were all conducted retrospectively. Although the results were conflicting regarding the impact of prior appendicectomy in the occurrence and relapse of CDI, it appears that the presence or absence of the appendix is not associated with the clinical severity of CDI. Based on the current evidence and considering the effects of the widespread use of antibiotics in the clinical practice, it appears that an in situ appendix does not have a definitive impact on the development and severity of CDI. Further observational studies are warranted to clarify any potential association.

• Appendicectomy
• Appendix
• Clostridium difficile
• Infection
• Pseudomembranous colitis
• Surgery

• Clostridium difficile infection
• management
• recurrent infection
• risk factors
• severe infection

AIM: To examine if fulminant Clostridium difficile infections (CDI) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease.

METHODS: A retrospective chart review was performed on patients who underwent colectomy for CDI between 2001 and 2011. The appendectomy rate was calculated based on the absence of an appendix on the surgical pathology report. This was compared to an established lifetime risk of appendectomy in the general population. A chart review was performed for mortality and traditional markers of CDI disease severity. Fisher’s exact test was used to calculate the likelihood of association between prior appendectomy, mortality, and clinical markers of severity of infection.

RESULTS: Fifty-five specimens were identified with pseudomembranous colitis consistent with CDI. All patients had a clinical history consistent with CDI and 45 of 55 (81.8%) specimens also had microbiological confirmation of CDI. Appendectomy was observed in 24 of 55 specimens (0.436, 99%CI: 0.280-0.606). This was compared to the lifetime incidence of appendectomy of 17.6%. The rate of appendectomy in our sample was significantly higher than would be expected in the general population (43.6% vs 17.6%, P < 0.01). Disease severity did not differ based on presence or absence of an appendix and no association was detected between prior appendectomy and mortality (OR = 0.588, 95%CI: 0.174-1.970).

CONCLUSION: The rate of appendectomy in the patients whose CDI led to colectomy, was significantly higher than the calculated lifetime risk, suggesting an association of appendectomy and severe CDI resulting in colectomy. Larger prospective studies are needed to assess any potential causal relationships affecting fulminant CDI.

• Appendectomy
• Fulminant colitis
• Clostridium difficile

The human appendix has historically been considered a vestige of evolutionary development with an unknown function. While limited data are available on the microbial composition of the appendix, it has been postulated that this organ could serve as a microbial reservoir for repopulating the gastrointestinal tract in times of necessity. We aimed to explore the microbial composition of the human appendix, using high-throughput sequencing of the 16S rRNA gene V4 region. Seven patients, 5 to 25 years of age, presenting with symptoms of acute appendicitis were included in this study. Results showed considerable diversity and interindividual variability among the microbial composition of the appendix samples. In general, however, Firmicutes was the dominant phylum, with the majority of additional sequences being assigned at various levels to Proteobacteria, Bacteroidetes, Actinobacteria, and Fusobacteria. Despite the large diversity in the microbiota found within the appendix, however, a few major families and genera were found to comprise the majority of the sequences present. Interestingly, also, certain taxa not generally associated with the human intestine, including the oral pathogens Gemella, Parvimonas, and Fusobacterium, were identified among the appendix samples. The prevalence of genera such as Fusobacterium could also be linked to the severity of inflammation of the organ. We conclude that the human appendix contains a robust and varied microbiota distinct from the microbiotas in other niches within the human microbiome. The microbial composition of the human appendix is subject to extreme variability and comprises a diversity of biota that may play an important, as-yet-unknown role in human health.

There are currently limited data available on the microbial composition of the human appendix. It has been suggested, however, that it may serve as a “safe house” for commensal bacteria that can reinoculate the gut at need. The present study is the first comprehensive view of the microbial composition of the appendix as determined by high-throughput sequencing. We have determined that the human appendix contains a wealth of microbes, including members of 15 phyla. Important information regarding the associated bacterial diversity of the appendix which will help determine the role, if any, the appendix microbiota has in human health is presented.