TY - JOUR
T1 - The potential of rectal swabs to differentiate simple and complex appendicitis in children with a microbiota-based test
AU - The, Sarah-May M. L.
AU - de Meij, Tim G. J.
AU - Budding, Andries E.
AU - Bakx, Roel
AU - van der Lee, Johanna H.
AU - Poort, Linda
AU - Cense, Huib A.
AU - Heij, Hugo A.
AU - van Heurn, L. W. Ernst
AU - Gorter, Ramon R.
N1 - Funding Information: This work was supported by the foundation of research and management projects in pediatric surgery (KCHOMP). The KCHOMP did not have any influence on the design or conduct of this study (grant total: € 8.000). Publisher Copyright: © 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Currently, accurate biomarkers differentiating simple (phlegmonous) from complex (gangrenous and/or perforated) appendicitis in children are lacking. However, both types may potentially require different treatment strategies, and the search for diagnostic modalities remains warranted. Previously, we demonstrated a distinct microbiota (both an increased bacterial diversity and abundance) in the appendix of children with complex compared to simple appendicitis. From the same cohort of patients we have collected 35 rectal swabs under general anesthesia prior to appendectomy and microbiota analysis was performed by IS-pro, a 16S-23S rDNA–based clinical microbiota profiling technique. Using the obtained IS-profiles, we performed cluster analyses (UPGMA), comparison of diversity (Shannon Diversity Index) and intensity (abundance in relative fluorescence units) on phylum level, and comparison on species level of bacteria between simple and complex appendicitis. Regarding these analyses, we observed no clear differences between simple and complex appendicitis. However, increased similarity of the microbial composition of the appendix and rectal swab was found within children with complex compared to simple appendicitis. Furthermore, PLS-DA regression analysis provided clear visual differentiation between simple and complex appendicitis, but the diagnostic power was low (highest AUC 0.65). Conclusion: Microbiota analysis of rectal swabs may be viable to differentiate between simple and complex appendicitis prior to surgery as a supervised classification model allowed for discrimination of both types. However, the current diagnostic power was low and further validation studies are needed to assess the value of this method.What is Known:• Simple andcomplex appendicitis in children may require different treatment strategies,but accurate preoperative biomarkers are lacking.• Clear differentiationcan be made between both types in children based upon the microbial compositionin the appendix.What is New:• Increased similaritywas found between the microbial composition of the appendix and rectal swabwithin children with complex compared to simple appendicitis.• Usinga supervised classification model rectal swabs may be viable to discriminatebetween simple and complex appendicitis, but the diagnostic power was low.
AB - Currently, accurate biomarkers differentiating simple (phlegmonous) from complex (gangrenous and/or perforated) appendicitis in children are lacking. However, both types may potentially require different treatment strategies, and the search for diagnostic modalities remains warranted. Previously, we demonstrated a distinct microbiota (both an increased bacterial diversity and abundance) in the appendix of children with complex compared to simple appendicitis. From the same cohort of patients we have collected 35 rectal swabs under general anesthesia prior to appendectomy and microbiota analysis was performed by IS-pro, a 16S-23S rDNA–based clinical microbiota profiling technique. Using the obtained IS-profiles, we performed cluster analyses (UPGMA), comparison of diversity (Shannon Diversity Index) and intensity (abundance in relative fluorescence units) on phylum level, and comparison on species level of bacteria between simple and complex appendicitis. Regarding these analyses, we observed no clear differences between simple and complex appendicitis. However, increased similarity of the microbial composition of the appendix and rectal swab was found within children with complex compared to simple appendicitis. Furthermore, PLS-DA regression analysis provided clear visual differentiation between simple and complex appendicitis, but the diagnostic power was low (highest AUC 0.65). Conclusion: Microbiota analysis of rectal swabs may be viable to differentiate between simple and complex appendicitis prior to surgery as a supervised classification model allowed for discrimination of both types. However, the current diagnostic power was low and further validation studies are needed to assess the value of this method.What is Known:• Simple andcomplex appendicitis in children may require different treatment strategies,but accurate preoperative biomarkers are lacking.• Clear differentiationcan be made between both types in children based upon the microbial compositionin the appendix.What is New:• Increased similaritywas found between the microbial composition of the appendix and rectal swabwithin children with complex compared to simple appendicitis.• Usinga supervised classification model rectal swabs may be viable to discriminatebetween simple and complex appendicitis, but the diagnostic power was low.
KW - Bacterial infections
KW - IS-pro
KW - Intestinal microbiota
KW - Pediatric surgery
KW - Rectal swabs
UR - http://www.scopus.com/inward/record.url?scp=85139671567&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00431-022-04627-0
DO - https://doi.org/10.1007/s00431-022-04627-0
M3 - Article
C2 - 36195698
SN - 0340-6199
VL - 181
SP - 4221
EP - 4226
JO - European journal of pediatrics
JF - European journal of pediatrics
IS - 12
ER -