Appendicectomy and clostridium difficile infection: is there a link?

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.