Appendectomy and risk of clostridium difficile recurrence

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.