Appendectomy as a Risk Factor for Bacteremic Biliary Tract Infection Caused by Antibiotic-Resistant Pathogens

Abstract

Background/Aims Recent evidence has suggested that appendix plays a pivotal role in the development and preservation of intestinal immune system. The aim of this study is to examine whether prior appendectomy is associated with an increased risk for the development of antibiotic-resistant bacteria in bacteremia from biliary tract infection (BTI). Methods Charts from 174 consecutive cases of bacteremia derived from BTI were retrospectively reviewed. Using multivariate analysis, independent risk factors for development of antibiotic-resistant bacteria were identified among the clinical parameters, including a history of appendectomy. Results In total, 221 bacteria strains were identified from 174 BTI events. Of those, 42 antibiotic-resistant bacteria were identified in 34 patients. Multivariate analysis revealed that prior appendectomy (Odds ratio (OR), 3.02; 95% confidence interval (CI), 1.15–7.87; p = 0.026), antibiotic use within the preceding three months (OR, 3.06; 95% CI, 1.26–7.64; p = 0.013), and bilioenteric anastomosis or sphincterotomy (OR, 3.77; 95% CI, 1.51–9.66; p = 0.0046) were independent risk factors for antibiotic-resistant bacteria. Conclusions Prior appendectomy was an independent risk factor for the development of antibiotic-resistant bacteria in bacteremia from BTI.

Developing a risk prediction model for multidrug-resistant bacterial infection in patients with biliary tract infection

“…There is therefore a critical need to identify, at the bedside, which patients are at high risk for infection with multidrug-resistant pathogens, so that initial empiric therapy can be targeted at these patients without adversely affecting the rest of the patients with BTI. Unfortunately, many previous studies[ 6 7 12 13 ] have only identified a few risk factors that lead to multidrug-resistant bacterial infections in BTI patients, but no model has been constructed to predict the probability of multidrug-resistant bacterial infections in individual patients. We used a nomogram to build a simple, convenient and repeatable bedside prediction tool which predicts multidrug-resistant bacteria infection and differentiates low versus high risk patients.…”

“…These five predictors are easy to obtain in clinical practice, even in developing countries, indicating that the model has a wide range of application. In the present study, the previous antibiotic use within 90 days and previous biliary surgery were not statistically significant in univariate analysis, but based on clinical experience and prior reports[ 5 6 7 12 13 ] we included these in the multivariate analysis. The results of multivariate analysis showed that previous antibiotic use within 90 days and previous biliary surgery were independent risk factors for multidrug-resistant bacterial infections.…”

“…This further proves that the previous history of biliary tract surgery was a risk factor for multidrug-resistant bacterial infections which concurred with those of previous studies. [ 7 13 ]…”

“…Although some previous studies[ 6 7 ] have identified independent risk factors associated with antibiotic-resistant bacteria in biliary tract infections, they were limited by focusing on specific bacteria, drugs or groups of patients. Further, without aggregating these risk factors, the utility of this information at the bedside is limited.…”

Appendectomy Is Associated With Alteration of Human Gut Bacterial and Fungal Communities

“…However, increasing evidence has revealed that the human appendix plays important biological roles in regulating the intestinal immune system and microbiome ( Randal Bollinger et al, 2007 ; Laurin et al, 2011 ; Masahata et al, 2014 ; Kooij et al, 2016 ; Girard-Madoux et al, 2018 ; Vitetta et al, 2019 ). Moreover, studies suggest that prior appendectomy may be associated with increased risk of many diseases, such as sarcoidosis, antibiotic-resistant bacteria-mediated bacteremia caused by biliary tract infection, gallstones, pyogenic liver abscesses, gastrointestinal cancers, Parkinson’s disease (PD), and rheumatoid arthritis ( Tzeng et al, 2015 ; Chung et al, 2016 ; Liao et al, 2016 ; Song et al, 2016 ; Kawanishi et al, 2017 ; Sawahata et al, 2017 ; Rubin, 2019 ). However, other studies have indicated no overall increase in cancer incidence several years after appendectomy ( Mellemkjaer et al, 1998 ; Cope et al, 2003 ).…”