Influence of prior appendectomy and cholecystectomy on Clostridioides difficile infection recurrence and mortality

Franko, Jan; Ferrel, Benjamin; Pierson, Paul; Raman, Shankar; Franková, Daniela; Rearigh, Lindsey; Afroze, Aneesa; Hernandez, Maria Antonia; Terrero-Salcedo, David; Kermode, David; Gorvet, Marc

doi:10.1016/j.amjsurg.2019.10.038

Cited by 6 publications

(5 citation statements)

References 20 publications

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“…No previous studies have investigated the relationship between remote cholecystectomy, development of AMR and PABSI outcomes. Several studies, however, have investigated the impact of cholecystectomy on C. difficile incident infection (CDI), recurrence and mortality [50, 51]. Given that cholecystectomy is associated with increased levels of fecal secondary bile acids which confer resistance to C. difficile infection in animal models, the authors proposed that cholecystectomy might protect against CDI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Remote Cholecystectomy on Clinical Outcomes FollowingPseudomonas aeruginosaBloodstream Infection: A Retrospective Cohort Study

Bertucci,

Heise,

Angarone

et al. 2024

Preprint

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Purpose: Mortality associated withPseudomonas aeruginosabloodstream infection (PABSI) remains high despite advances in clinical care and therapeutics. In a recent study using mice to model PABSI, the gallbladder (GB) was identified as a reservoir for bacterial expansion. Furthermore, bile exposure has been linked to increased antimicrobial resistance (AMR). Therefore, we asked whether patients with retained gallbladders might suffer from more antimicrobial resistantP. aeruginosa(Pa) infections, extended culture positivity, and worsened clinical outcomes. Methods: Retrospective cohort study of adults hospitalized over a five-year period with PABSI. PABSI cases were defined as patients with ≥ 1 positivePabacterial culture from the blood. Patients were categorized as either those retaining a gallbladder (no cholecystectomy) or those without (cholecystectomy). Cholecystectomy was defined as a history of cholecystectomy ≥ 1 year prior to the index episode of PABSI. Inferential statistics were used to identify associations between remote cholecystectomy and antimicrobial resistance profile, length of blood culture positivity, and in-hospital and 90-day mortality. Results: The final study population included 336 patients, 262 (78%) with retained gallbladder and 74 (22%) without. We observed no difference in 90-day or in-hospital mortality between groups. Overall, composite 90-day mortality was 30.1%. Furthermore, no robust differences were observed in the antimicrobial resistance profile of Pa isolates between the groups. Conclusions: In our study, neither PABSI AMR pattern nor clinical outcome was affected by remote cholecystectomy. However, we do demonstrate that mortality for patients with PABSI in the modern era remains high despite advances in anti-pseudomonal therapeutics.

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Section: Discussionmentioning

confidence: 99%

“…Patients without a gallbladder did not experience higher rates of incident CDI or recurrence. However, there was a significant increase in mortality in patients following cholecystectomy [51]. The reason for the increase in mortality is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

Impact of Remote Cholecystectomy on Clinical Outcomes FollowingPseudomonas aeruginosaBloodstream Infection: A Retrospective Cohort Study

Bertucci,

Heise,

Angarone

et al. 2024

Preprint

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“…Ward et al [ 29 ], studied the presence and severity of CDI in relation to the presence or absence of an appendix, which did not demonstrate a statistically significant association. More recently, two further analyses demonstrated that C. difficile recurrence rate is not affected by a prior appendectomy[ 30 ], nor is there any statistical difference in the severity or complications of CDI in the presence or absence of the appendix[ 31 ]. It is worth noting that all of the above mentioned negative studies had a smaller patient population compared to ours, with most under 500 patients.…”

Section: Discussionmentioning

confidence: 99%

Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

Shaikh¹,

Patel²,

Munshi³

et al. 2021

WJGS

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BACKGROUND 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. AIM To study the impact of prior appendectomy on the severity and outcomes of CDI. METHODS 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. RESULTS 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). CONCLUSION 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.

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“…According to Im et al, patients who had an appendectomy done were found to have an increased risk of recurrent CDI and were also associated with a more severe clinical course [13]. In contrast, Franko et al found no effect of appendectomy status on recurrence of CDI [14]. The aim of our study was to determinate CDI recurrence, severity, complications, and length of hospital stay in patients with and without prior history of appendectomy who were admitted to the hospital with CDIs.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Appendectomy in Clostridium difficile Infection and Length of Hospital Stay

Saturno¹,

Mehershahi²,

Essrani³

et al. 2020

Cureus

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We aim to investigate Clostridium difficile infection (CDI) recurrence, severity, complications, and length of hospital stay in patients with and without prior history of appendectomy who were admitted to the hospital with CDI. Method We analyzed retrospective data for 862 patients, 18 years and older, with C. difficile inpatients diagnosed between January 1, 2017 and December 31, 2018 and sorted into two groups, with or without prior appendicectomy, to look for outcomes such as recurrence, hospital stay, complications, and related death in each group and use statistical analysis for comparison.

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Influence of prior appendectomy and cholecystectomy on Clostridioides difficile infection recurrence and mortality

Cited by 6 publications

References 20 publications

Impact of Remote Cholecystectomy on Clinical Outcomes FollowingPseudomonas aeruginosaBloodstream Infection: A Retrospective Cohort Study

Impact of Remote Cholecystectomy on Clinical Outcomes FollowingPseudomonas aeruginosaBloodstream Infection: A Retrospective Cohort Study

Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

The Impact of Appendectomy in Clostridium difficile Infection and Length of Hospital Stay

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