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Appendectomy and Risk of Clostridium difficile Recurrence

Fujii, Larissa MD*; Fasolino, John MD*; Crowell, Michael D. PhD; DiBaise, John K. MD

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31826e80e0
Original Articles
Abstract

Background: A number of risk factors have been identified for the development of recurrent Clostridium difficile infection (CDI). Although controversial, it has been suggested that the appendix plays an active role in the human immune system and may help restore the normal colonic microbiota and protect it from pathogenic bacterial colonization and infection. We sought to determine whether the presence or absence of the appendix was associated with differences in the severity and risk of recurrence of CDI.

Methods: A retrospective review of patients with a stool positive for C difficile detected between January 2005 and December 2009 was performed. Pertinent data were collected using a standardized form, and the differences between those with and without an appendix were compared.

Results: Records of 569 patients were reviewed; 81 patients had a prior appendectomy. Presenting symptoms were similar between those with and without an appendix, except those without an appendix had a longer course of diarrhea before the diagnosis of CDI (P = 0.003). There was no significant association between appendectomy and recurrence (odds ratio, 0.73; 95% confidence interval, 0.37–1.45) or severity (odds ratio, 0.57; 95% confidence interval, 0.30–1.09) of CDI. Multivariable logistic regression controlling for age, sex, diarrhea, appendectomy, and proton pump inhibitor use showed that only additional antibiotic use was significantly associated with CDI recurrence.

Conclusions: The presence of an appendix does not seem to reduce the severity or risk of recurrence of C difficile infection.

Author Information

From the *Department of Internal Medicine and †Division of Gastroenterology, Mayo Clinic, Scottsdale, AZ.

Correspondence to: John K. DiBaise, MD, Division of Gastroenterology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259. E-mail: dibaise.john@mayo.edu.

The authors have no funding or conflicts of interest to disclose.

Authors’ contributions: LF: study design, acquisition of data, and analysis and interpretation of data; drafting the manuscript and revising it critically for important intellectual content; and gave final approval of the version to be published. JF: study conception and design, revision of the manuscript, and gave final approval of the version to be published. MDC: study design, analysis and interpretation of data, revision of the manuscript, and gave final approval of the version to be published. JKD: study conception and design, analysis and interpretation of data; drafting the manuscript and revising it critically for important intellectual content, and gave final approval of the version to be published.

© 2013 Lippincott Williams & Wilkins, Inc.