The association between bowel resection and the risk of nontyphoidal salmonella infection: a nationwide propensity score-matched cohort study

Kuang-Tsu Yang,Hei-Tung Yip,Sin-Ei Juang,Yao-Min Hung,James Cheng-Chung Wei,Renin Chang

doi:10.1038/s41598-021-81224-5

Abstract

Nontyphoidal salmonella (NTS) infection has a high mortality rate. Bowel resections affect gut microbiota and immune function, and the association between bowel resection and NTS infection in human beings has not been addressed. We conducted a nationwide propensity score (PS)-matched cohort study to clarify this association. Data from the Longitudinal Health Insurance Database of Taiwan were used to establish a case-cohort with bowel resections from 2000 to 2013. Informed consent was waived by the Institutional Review Board of China Medical University Hospital (CMUH104-REC2-115) because all personal identifying information used had been de-identified. Each case was matched with one control without any bowel resection according to age, gender, index date, and propensity score (PS). Cumulative incidences of and hazard ratios (HRs) for NTS infection development were analyzed. The incidence of NTS infection was greater in patients with a bowel resection than in the control group (2.97 vs. 1.92 per 10,000 person-years), with an adjusted hazard ratio (aHR) of 1.64 (95% CI = 1.08–2.48). The incidence of NTS infection increased significantly for cases with small bowel resections and right hemicolectomies. Age (31–40 and > 50 years), hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and autoimmune diseases were significant risk factors of NTS infection. Stratification analysis revealed that patients without comorbidities were prone to NTS infection after bowel resections. The increased risk of developing NTS infection could be related to the bowel resection. Specific age groups and comorbidities also contribute to increased risk of NTS infection.

Highlights

Nontyphoidal salmonella (NTS) infection has a high mortality rate
The Incidence rates (IRs) of NTS infection was higher in the bowel resection group than in the control group (2.97 vs. 1.92 per 10,000 person-years), with an adjusted hazard ratio (aHR) of 1.64 for the bowel resection group (Table 2)
Considering the location of bowel resection, the IR of NTS infection was higher in the small bowel resection group than in the control group (3.66 vs. 1.92 per 10,000 person-years), with an aHR of 1.96 for the small bowel resection group, and higher in the right hemicolectomy group than in the control group (3.32 vs. 1.92 per 10,000 person-years), with an aHR of 1.96 for the right hemicolectomy group

Summary

Introduction

Nontyphoidal salmonella (NTS) infection has a high mortality rate. Bowel resections affect gut microbiota and immune function, and the association between bowel resection and NTS infection in human beings has not been addressed. Each case was matched with one control without any bowel resection according to age, gender, index date, and propensity score (PS). The incidence of NTS infection was greater in patients with a bowel resection than in the control group (2.97 vs 1.92 per 10,000 person-years), with an adjusted hazard ratio (aHR) of 1.64 (95% CI = 1.08–2.48). The incidence of NTS infection increased significantly for cases with small bowel resections and right hemicolectomies. Bowel resection strongly influences gut microbiota and intestinal healing[9]. Kunz et al indicated that gastrectomy could lead to S. enteritis This might result from relative or absolute achlorhydria, decreased hydrogen ion concentration, rapid emptying of food into the small intestine and the colon and altered bacterial flora[10]

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Results

Conclusion