Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial

Vanhatalo, Sanja; Munukka, Eveliina; Sippola, Suvi; Jalkanen, Sirpa; Grönroos, Juha; Marttila, Harri; Eerola, Erkki; Hurme, Saija; Hakanen, Antti

doi:10.1136/bmjopen-2019-031137

Cited by 25 publications

(22 citation statements)

References 36 publications

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“…and P. aeruginosa have also been shown to be a factor. [27,28] Our study was found to be compatible with the literature in this respect. It is difficult to explain the effects of these agents on infection, since the species identified in appendicitis were found to be compatible with the gastrointestinal microbiota, according to studies conducted with both new generation sequencing and culture methods.…”

Section: Discussionsupporting

confidence: 91%

“…It is difficult to explain the effects of these agents on infection, since the species identified in appendicitis were found to be compatible with the gastrointestinal microbiota, according to studies conducted with both new generation sequencing and culture methods. [28] In addition, microbiota profiles vary from person to person. Although factors such as diet, geography, medicines (antibiotics, etc.…”

Section: Discussionmentioning

confidence: 99%

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Does the Covid-19 pandemic have an effect on wound culture in patients undergoing appendectomy? A Case Control Study

Bolat

MUTLU

2022

Journal of Contemporary Medicine

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The aim of this study is to examine the effect of the changing microbiota structure during the pandemic period on the bacterial aerobic culture profile of the wound taken from patients operated for acute appendicitis, together with clinical variables. Material and Method:Our study included 125 patients who underwent an appendectomy in the General Surgery Clinic between 01.03.2019-01.02.2021 and whose wound culture was taken during an appendectomy. The patients were divided into two groups; group1 (pre-pandemic) and group2 (during a pandemic). Both groups were compared in terms of age, gender, clinical, laboratory and wound culture data.Results: There was no significant difference between the groups in terms of age, clinical symptoms, surgical method, laboratory and radiological data (p>0.05). In the pre-pandemic group, there was growth of Escherichia coli in 35 (53%) patients, Klebsiella pneumoniae in 3 (4.5%) patients, and Pseudomanas aeruginosae in 2 (3) patients from Gram-negative bacteria while Streptecoccus anginosus and Strep. constellatus growth were most common from Gram-positive bacteria. In the pandemic group, there was the growth of E. coli in 29 (49.2%) patients, P. aeruginosae in 5 (8.5%) patients, K. pneumoniae in 2 (3.4%) patients from Gram-negative bacteria, Citrobacter freundii and Strep. anginosus growth were the most common from Gram-positive bacteria. E. coli is the most common bacteria in both groups.Conclusion: Although E. coli was found to be the most frequently identified microorganism in patients with acute appendicitis, an increase in the density and resistance of Pseudomonas group bacteria were detected, possibly due to the effect of the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Does the Covid-19 pandemic have an effect on wound culture in patients undergoing appendectomy? A Case Control Study

Bolat

MUTLU

2022

Journal of Contemporary Medicine

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“…Interestingly, two recent trial study protocols describe one trial planning to compare antibiotics with placebo for nonperforated appendicitis in adults and another trial designed to investigate microbiota and effects of antimicrobial treatment of appendicitis in adults. [35,36]…”

Section: Future Perspectivesmentioning

confidence: 99%

Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

et al. 2019

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Acute appendicitis is the most common surgical emergency in children. Nonoperative treatment of nonperforated acute appendicitis in children is an alternative to appendectomy. The purpose of this systematic review and meta-analysis was to determine the outcomes of nonoperative treatment of nonperforated acute appendicitis in children in the literature. Databases were searched to identify abstracts, using predefined search terms. The abstracts were reviewed by two independent reviewers and articles were selected according to inclusion and exclusion criteria. Data were extracted by the two reviewers and analyzed. The literature search yielded 2743 abstracts. Twenty-one articles were selected for analysis. The study design was heterogenous, with only one randomized controlled study. The symptoms resolved in 92% [95% CI (88; 96)] of the nonoperatively treated patients. Meta-analysis showed that an additional 16% (95% CI 10; 22) of patients underwent appendectomy after discharge from initial hospital stay. Complications and length of hospital stay was not different among patients treated with antibiotics compared with those who underwent appendectomy. Nonoperative treatment of nonperforated acute appendicitis children is safe and efficient. There is a lack of large randomized controlled trials to compare outcomes of nonoperative treatment with appendectomy.

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“…Although not yet researched, the availability of metformin in the appendix 6 and the anti-inflammatory, anti-microbial and immune modulatory properties of metformin 7 , 8 could partly explain such a reduced risk. Gut immune-microbe interaction may play an important role in the development of acute appendicitis 21 and a prospective clinical trial investigating the relationship between gut microbiota and acute appendicitis is being conducted 22 . Fusobacteria infection has been linked to acute appendicitis 23 and Akkermansia muciniphila (a mucin-degrading bacterium that colonizes in the mucus layer and improves intestinal barrier function) 24 is inversely associated with the severity of acute appendicitis 23 .…”

Section: Discussionmentioning

confidence: 99%

Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

Tseng

2021

Sci Rep

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This retrospective cohort study used the nationwide database of Taiwan’s National Health Insurance to investigate whether metformin would reduce the risk of acute appendicitis in patients with type 2 diabetes mellitus. We first identified 423,949 patients newly diagnosed of diabetes from 1999 to 2005. After excluding patients having type 1 diabetes mellitus, missing data, previous history of acute appendicitis, aged < 15 years, aged > 80 years and followed up for < 6 months, 338,172 ever users and 21,861 never users of metformin were followed up from January 1, 2006 until December 31, 2011. Incidence of acute appendicitis was estimated for never users, ever users and subgroups (divided by median, tertiles and quartiles, respectively) of dose–response indicators including cumulative duration (months), cumulative dose (mg) and average daily dose (mg/day) of metformin therapy. We used Cox regression incorporated with the inverse probability of treatment weighting using propensity score to estimate the overall hazard ratio for ever versus never users, and the hazard ratios for subgroups of dose–response indicators versus never users. Results showed that new-onset acute appendicitis was diagnosed in 1558 ever users and 179 never users during follow-up. The incidence was 98.15 per 100,000 person-years in ever users and was 189.48 per 100,000 person-years in never users. The overall hazard ratio (95% confidence interval) of 0.514 (0.441–0.600) suggested a lower risk of acute appendicitis associated with metformin use. A dose–response pattern was consistently observed in the analyses of different subgroups of dose–response indicators and the reduced risk associated with metformin use was consistently observed in various sensitivity analyses. An average daily dose of 1000–1500 mg/day can significantly reduce the risk by > 50%. The benefit did not differ between different formulations of metformin, and the estimated hazard ratio for conventional/immediate-release metformin versus never users was 0.516 (0.441–0.603) and was 0.509 (0.421–0.615) for prolonged/slow-release metformin versus never users. It is concluded that metformin use is associated with a reduced risk of acute appendicitis in patients with type 2 diabetes mellitus.

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Prospective multicentre cohort trial on acute appendicitis and microbiota, aetiology and effects of antimicrobial treatment: study protocol for the MAPPAC (Microbiology APPendicitis ACuta) trial

Cited by 25 publications

References 36 publications

Does the Covid-19 pandemic have an effect on wound culture in patients undergoing appendectomy? A Case Control Study

Does the Covid-19 pandemic have an effect on wound culture in patients undergoing appendectomy? A Case Control Study

Nonoperative treatment for nonperforated appendicitis in children: a systematic review and meta-analysis

Metformin use is associated with a reduced risk of acute appendicitis in Taiwanese patients with type 2 diabetes mellitus

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