title: Fulminant Clostridium difficile infection: An association with prior appendectomy?
abstract: OBJECTIVE
  To examine if fulminant Clostridium difficile infections (CDI) resulting in colectomy was associated with a prior appendectomy and whether any association affected the severity of the disease.
  
  
  METHODS
  A retrospective chart review was performed on patients who underwent colectomy for CDI between 2001 and 2011. The appendectomy rate was calculated based on the absence of an appendix on the surgical pathology report. This was compared to an established lifetime risk of appendectomy in the general population. A chart review was performed for mortality and traditional markers of CDI disease severity. Fisher's exact test was used to calculate the likelihood of association between prior appendectomy, mortality, and clinical markers of severity of infection.
  
  
  RESULTS
  Fifty-five specimens were identified with pseudomembranous colitis consistent with CDI. All patients had a clinical history consistent with CDI and 45 of 55 (81.8%) specimens also had microbiological confirmation of CDI. Appendectomy was observed in 24 of 55 specimens (0.436, 99%CI: 0.280-0.606). This was compared to the lifetime incidence of appendectomy of 17.6%. The rate of appendectomy in our sample was significantly higher than would be expected in the general population (43.6% vs 17.6%, P < 0.01). Disease severity did not differ based on presence or absence of an appendix and no association was detected between prior appendectomy and mortality (OR = 0.588, 95%CI: 0.174-1.970).
  
  
  CONCLUSIONS
  The rate of appendectomy in the patients whose CDI led to colectomy, was significantly higher than the calculated lifetime risk, suggesting an association of appendectomy and severe CDI resulting in colectomy. Larger prospective studies are needed to assess any potential causal relationships affecting fulminant CDI.
authors: Jesse Clanton, Michael Subichin, Michael S Firstenberg, Department of Surgery, Northeast Ohio Medical University, Summa Akron City Hospital, Akron, OH 44304, United States.
authors: Jesse
authors: J
authors: Clanton
authors: Michael
authors: M
authors: Subichin
authors: Katherine
authors: K
authors: Drolshagen
authors: Timothy
authors: T
authors: Daley
authors: Michael S
authors: MS
authors: Firstenberg
keywords: Appendectomy; Clostridium difficile; Fulminant colitis
references: Adv Data. 2007 Jul 12;(385):1-19
references: 17691217
references: Clin Gastroenterol Hepatol. 2011 Dec;9(12):1072-7
references: 21699818
references: Compr Ther. 2004 Fall-Winter;30(3):134-40
references: 15793312
references: Natl Health Stat Report. 2012 Sep 27;(57):1-15
references: 24979977
references: Curr Opin Infect Dis. 2011 Aug;24(4):370-6
references: 21505332
references: Lancet. 1989 May 27;1(8648):1156-60
references: 2566734
references: Clin Microbiol Infect. 2001 Aug;7(8):405-10
references: 11591202
references: J Clin Pathol. 1997 Jan;50(1):70-1
references: 9059362
references: Infect Control Hosp Epidemiol. 2011 Mar;32(3):220-8
references: 21460506
references: Arch Surg. 2007 Jul;142(7):624-31; discussion 631
references: 17638799
references: J Clin Med Res. 2012 Feb;4(1):17-9
references: 22383922
references: Adv Ther. 2011 Mar;28(3):195-201
references: 21327753
references: Am J Epidemiol. 1990 Nov;132(5):910-25
references: 2239906
references: Br J Surg. 2009 May;96(5):473-81
references: 19358184
references: Br J Surg. 2012 Nov;99(11):1501-13
references: 22972525
references: Clin Gastroenterol Hepatol. 2007 Aug;5(8):969-71
references: 17625978
references: J Theor Biol. 2007 Dec 21;249(4):826-31
references: 17936308
references: Am J Clin Nutr. 1980 Nov;33(11 Suppl):2521-6
references: 7435423
references: Pediatrics. 2009 Mar;123 Suppl 3:S131-45
references: 19221156
references: Ann Med. 1990 Feb;22(1):61-7
references: 2184849
references: Am J Public Health. 1989 Apr;79(4):437-40
references: 2784635
references: Am J Gastroenterol. 2013 Apr;108(4):626-7
references: 23552320
references: J Evol Biol. 2009 Oct;22(10):1984-99
references: 19678866
references: Surg Infect (Larchmt). 2007 Dec;8(6):557-66
references: 18171114
references: Am J Obstet Gynecol. 2003 Dec;189(6):1563-7; discussion 1567-8
references: 14710065
references: Infect Control Hosp Epidemiol. 2012 May;33(5):470-6
references: 22476273