Shaikh DH, Patel H, Munshi R, Sun H, Mehershahi S, Baiomi A, Alemam A, Pirzada U, Nawaz I, Naher K, Hanumanthu S, Nayudu S. Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes. World J Gastrointest Surg 2021; 13(11): 1436-1447 [PMID: 34950432 DOI: 10.4240/wjgs.v13.i11.1436]
Corresponding Author of This Article
Danial Haris Shaikh, MD, Doctor, Division of Gastroenterology, Department of Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, United States. dshaikh@bronxcare.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Nov 27, 2021; 13(11): 1436-1447 Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1436
Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes
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
Danial Haris Shaikh, Harish Patel, Haozhe Sun, Shehriyar Mehershahi, Ahmed Baiomi, Ahmed Alemam, Siddarth Hanumanthu, Suresh Nayudu, Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
Rezwan Munshi, Department of Medicine, Nassau University Medical Center, New York, NY 11554, United States
Usman Pirzada, Iqra Nawaz, Kamrun Naher, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States
Author contributions: Shaikh DH and Patel H contributed planned, designed, conducted and analyzed the result of the study as well as drafted the manuscript; Munshi R, Sun H, Mehershahi S, Baiomi A, Alemam A and Pirzada U contributed acquired the data for the study and were involved in the critical revision of the manuscript; Nawaz I and Naher K contributed acquired the data for the study and were involved in the critical revision of the manuscript; Hanumanthu S acquired the data for the study and was involved in the critical revision of the manuscript; Nayudu S contributed supervised the design and conduct of the study as well as provided interpretation of the study results; Nayudu S was also involved in drafting, critical revision; all authors are involved in the final review and approval of the manuscript for submission.
Institutional review board statement: The study protocol was approved by the Institution Review Board at BronxCare Health System and was performed as per the Declaration of Helsinki (IRB No. 12131804).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data, that was obtained after each patient had agreed to the hospital evaluation and treatment via written consent.
Conflict-of-interest statement: All authors report no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Danial Haris Shaikh, MD, Doctor, Division of Gastroenterology, Department of Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, United States. dshaikh@bronxcare.org
Received: July 18, 2021 Peer-review started: July 18, 2021 First decision: August 15, 2021 Revised: August 29, 2021 Accepted: September 15, 2021 Article in press: September 15, 2021 Published online: November 27, 2021 Processing time: 131 Days and 13.5 Hours
ARTICLE HIGHLIGHTS
Research background
Clostridium difficile (C. difficile) is the leading cause of hospital-acquired diarrhea in the United States and accounts for significant morbidity, mortality and healthcare costs.
Research motivation
The vermiform appendix hosts immune tissue and favorable gut microbiota, which may indirectly influence the disease course and outcomes in C. difficile infection (CDI).
Research objectives
We aimed to study the association between prior appendectomy and outcomes (severity, recurrence, mortality) of CDI.
Research methods
Retrospective review of 1580 patients with CDI, assessing mortality and severity based on the presence or absence of the appendix, using logistic regression and propensity score analysis.
Research results
There was no statistical difference in mortality between C. difficile 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] and was also associated with the development of toxic megacolon (OR = 5.37, P < 0.05), and colectomy (OR = 2.77, P < 0.05).
Research conclusions
A history of appendectomy may lead to worse outcomes in CDI, likely secondary to an attenuated response to the dysbiosis of the gut, leading to an increased inflammatory reaction.
Research perspectives
Clinicians should be aware of the association between CDI and a history of appendectomy, and may consider screening all patients with C. difficile for a history of appendectomy. Further investigation into stronger antibiotic regimens or earlier institution of fecal microbiota transplantation for patients with prior appendectomy should be conducted if larger prospective studies can confirm and validate our results.
