title: Appendectomy: a risk factor for colectomy in patients with Clostridium difficile.
abstract: BACKGROUND
  The appendix, considered an intestinal microbiota reservoir, may be protective against the risk of fulminant Clostridium difficile infection.
  
  
  METHODS
  Retrospective analysis was performed in patients with C. difficile infection at St. Francis Medical Center from 2007 to 2011. Outcome of infection and history of appendectomy were compared. Statistical analysis was by chi-square and multivariate logistic regression.
  
  
  RESULTS
  In total, 507 patients were hospitalized for C. difficile. Of 388 patients with intact appendix, 20 (5.2%) developed fulminant infection and required colectomy, whereas of 119 patients with previous appendectomy, 13 (10.9%) required colectomy. An increased severity of disease, indicated by increased rate of colectomy, occurred for the group with a history of appendectomy (P = .03). Age and sex were adjusted by multivariant regression (P = .05).
  
  
  CONCLUSIONS
  Appendectomy may be a risk factor for increased severity of C. difficile infection. Although the mechanism is unknown, further studies are warranted.
authors.affiliation: Department of Surgery, University of Illinois-Peoria, 624 NE Glen Oak Ave. Peoria IL 61603-3135, USA. Electronic address: fyong1987@gmail.com.
authors.forename: Felix A
authors.initials: FA
authors.lastname: Yong
authors.affiliation: Department of Surgery, University of Illinois-Peoria, 624 NE Glen Oak Ave. Peoria IL 61603-3135, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Alvarado
authors.affiliation: Center for Health Outcome Research, University of Illinois-Peoria, 624 NE Glen Oak Ave. Peoria IL 61603-3135, USA.
authors.forename: Huaping
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Surgery, Kaiser Permanente-Los Angeles Medical Center, CA, USA.
authors.forename: Jerry
authors.initials: J
authors.lastname: Tsai
authors.affiliation: Department of Surgery, University of Illinois-Peoria, 624 NE Glen Oak Ave. Peoria IL 61603-3135, USA.
authors.forename: Norman C
authors.initials: NC
authors.lastname: Estes
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000379:methods*; D001064:Appendicitis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003082:Colectomy; D004761:Enterocolitis, Pseudomembranous / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Appendectomy; Clostridium difficile; Colectomy; Risk factors