History of Cholecystectomy and Risk of Clostridium Difficile Infection
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ORIGINAL ARTICLE
History of Cholecystectomy and Risk of Clostridium Difficile Infection Anqi Jin1 · Tony Chien2 · Qiwen Huang1 · Pragati Kenkare1 · Mai Vu1 · Sandra Wilson3 · Edward S. Huang4 Received: 3 April 2020 / Accepted: 10 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Cholecystectomy affects bile acid physiology. There is growing evidence that both primary and secondary bile acids play a role in the pathogenesis of Clostridium difficile infections (CDIs). Aims The aim of this study is to elucidate the relationship and risk of CDI in patients with cholecystectomy. Methods We performed a matched cohort study of patients in an integrated healthcare system in Northern California from January 2000 to December 2018. Patients with cholecystectomy (cases, n = 12,617) identified based on Current Procedure Terminology codes were age- and sex-matched to patients without cholecystectomy (controls, n = 37,851). We excluded those with history of CDI at baseline and calculated the hazard ratio (HR) for development of CDI after adjusting for confounders. Results We found total of 351 incident CDI during average of 4.66 years of follow-up among cases and controls. In multivariate analysis, cholecystectomy was associated with elevated risk of CDI (HR 1.53, 95% confidence interval 1.14– 2.04) compared with controls. Stratified analysis shows this effect does not differ according use of proton pump inhibitors (Pinteraction = 0.142), antibiotics (Pinteraction = 0.387), and hospitalization (Pinteraction = 0.252). Conclusions Cholecystectomy is associated with mild increased risk of incident CDI, but this effect is not influenced by use of proton pump inhibitors, antibiotics, or hospitalization. Future prospective studies should be conducted to validate these findings and evaluate bile acid changes after a cholecystectomy. Keywords Cholecystectomy · Clostridium difficile infection · Bile acid
Introduction CDI has been become a growing epidemic in recent years. Infection rates have doubled from 1996 to 2003 with mortality rates of up to 20,000 cases per year [1]. Treatment for CDI has become more challenging despite the advent of new
* Edward S. Huang [email protected] Anqi Jin [email protected] Tony Chien [email protected] Qiwen Huang [email protected] Pragati Kenkare [email protected] Mai Vu [email protected]
antibiotics, probiotics, immunotherapy, and more recently the use of fecal microbial transplantation (FMT). The pathogenesis of CDI requires the germination of spores to produce the necessary toxins to induce infection [2]. Growing evidence has suggested the role of bile acids in spore germination and disease pathogenesis. Studies have 1
Sutter Health, Center for Health Systems Research, Palo Alto Medical Foundation Research Institute, 795 E. El Camino Real, Palo Alto 94301, USA
2
Department of Medicine, Kaohsiung Medical School, No. 100, Shiquan 1st Road, Sanmin District, Kaohsiung City 807, Taiwan
3
Department of Medici
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