Shaikh Danial Haris, Patel Harish, Munshi Rezwan, Sun Haozhe, Mehershahi Shehriyar, Baiomi Ahmed, Alemam Ahmed, Pirzada Usman, Nawaz Iqra, Naher Kamrun, Hanumanthu Siddarth, Nayudu Suresh
Division of Gastroenterology, Department of Medicine, BronxCare Health System, Bronx, NY 10457, United States.
Department of Medicine, Nassau University Medical Center, New York, NY 11554, United States.
World J Gastrointest Surg. 2021 Nov 27;13(11):1436-1447. doi: 10.4240/wjgs.v13.i11.1436.
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% 14%, = 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, < 0.05). On multivariable analysis of secondary outcomes, prior appendectomy was also associated with toxic megacolon (OR = 5.37, < 0.05) and colectomy (OR = 2.77, < 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.
艰难梭菌感染（CDI）是由于结肠生态失调所致。阑尾被认为是肠道微生物群的“安全屋”，可能有助于艰难梭菌感染患者重新定植肠道菌群。
研究既往阑尾切除术对艰难梭菌感染严重程度及预后的影响。
我们回顾性分析了2008年至2018年间我院收治的1580例艰难梭菌感染患者的数据。根据是否有阑尾将患者分组。主要目的是：（1）评估全因死亡率；（2）艰难梭菌感染的严重程度。严重程度根据美国传染病学会标准定义。进行了逻辑回归分析，并使用治疗权重的逆概率（IPTW）进行倾向评分分析。
在1580例患者中，12.5%有阑尾切除术史。既往有阑尾切除术和无阑尾切除术的患者死亡率无统计学差异（13.7%对14%，P = 0.877）。然而，阑尾切除术史影响了艰难梭菌感染的严重程度[比值比（OR）= 1.32，95%置信区间：1.01 - 1.75]。在IPTW分析中，这种关联仍然显著（OR = 1.59，P < 0.05）。在对次要结局的多变量分析中，既往阑尾切除术还与中毒性巨结肠（OR = 5.37，P < 0.05）和结肠切除术（OR = 2.77，P < 0.05）相关。
既往阑尾切除术可能影响艰难梭菌感染的严重程度、中毒性巨结肠的发生以及最终结肠切除术的必要性。由于艰难梭菌感染的治疗取决于其严重程度，对于既往有阑尾切除术的患者，更强的抗生素方案或更早使用粪便微生物群移植可能是一个可行的选择。
