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Lou C, Meng Z, Shi Y, Zheng R, Pan J, Qian S. Causal effects of genetically vitamins and sepsis risk: a two-sample Mendelian randomization study. BMC Infect Dis 2023; 23:766. [PMID: 37936083 PMCID: PMC10629037 DOI: 10.1186/s12879-023-08778-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND In recent years, observational studies have been conducted to investigate the potential impact of vitamins on sepsis. However, many of these studies have produced inconsistent results. Our Mendelian randomization (MR) study aims to evaluate the causality between vitamins and sepsis from a genetic perspective. METHODS Our MR study was designed following the STROBE-MR guidelines. Genetic instrumental variables for vitamins including folate, vitamin B12, B6, A (Retinol), C, D, and K were obtained from previous genome-wide association studies (GWAS) and MR studies. Five different sepsis severity levels were included in the analysis. The genetic instrumental variables were screened for potential confounders using PhenoScanner V2. MR analysis was performed using MR-egger, inverse-variance weighted multiplicative random effects (IVW-RE), inverse-variance weighted multiplicative fixed-effects (IVW-FE), and wald ratio methods to assess the relationship between vitamins and sepsis. Sensitivity analysis was performed using the MR-egger_intercept method, and the MR-PRESSO package and Cochran's Q test were used to evaluate the heterogeneity of the instrumental variables. RESULTS Our MR study found no statistically significant association between vitamins and sepsis risk, regardless of the type of vitamin (P-value > 0.05). The odds ratios (ORs) for folate, vitamin B6, vitamin B12, vitamin A, vitamin D, vitamin K, and vitamin C were 1.164 (95% CI: 0.895-1.514), 0.987 (95% CI: 0.969-1.005), 0.975 (95% CI: 0.914-1.041), 0.993 (95% CI: 0.797-1.238), 0.861 (95% CI: 0.522-1.42), 0.955 (95% CI: 0.86-1.059), and 1.049 (95% CI: 0.911-1.208), respectively. Similar results were observed in subgroups of different sepsis severity levels. CONCLUSIONS Our MR study found no evidence of a causal association between vitamins and sepsis risk from a genetic perspective. Further randomized controlled trials are necessary to confirm these results.
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Affiliation(s)
- Chen Lou
- School of The First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, 325000, China
| | - Zhizhen Meng
- Department of Emergency, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Yiyi Shi
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Rui Zheng
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310016, China
| | - Jingye Pan
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
- Wenzhou Key Laboratory of Critical Care and Artificial Intelligence, Wenzhou, China.
- Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Provincial, Wenzhou, Zhejiang, 325000, People's Republic of China.
- Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, Wenzhou, Zhejiang, 325000, China.
| | - Songzan Qian
- Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Chakraborty A. Staphylococcal Carriage Status: Implications, Mechanisms and Practical Guidelines. Indian Dermatol Online J 2023; 14:530-534. [PMID: 37521232 PMCID: PMC10373815 DOI: 10.4103/idoj.idoj_562_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 08/01/2023] Open
Affiliation(s)
- Atreyo Chakraborty
- Department of Dermatology Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Sanford BS, Aliano JL, Omary CS, McDonnell SL, Kimball SM, Grant WB. Exposure to a Vitamin D Best Practices Toolkit, Model, and E-Tools Increases Knowledge, Confidence, and the Translation of Research to Public Health and Practice. Nutrients 2023; 15:nu15112446. [PMID: 37299409 DOI: 10.3390/nu15112446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Preventable vitamin D deficiency (VDD) is a global health concern. The prevention, early detection, and treatment of vitamin D deficiency aligning with serum 25-hydroxyvitamin D concentration recommendations of 40-60 ng/mL (100-150 nmol/L), provided by an international panel of 48 vitamin D researchers, would result in significant health benefits and cost savings to individuals and society. However, research shows that healthcare professionals lack knowledge and confidence in best practices with respect to vitamin D. A vitamin D toolkit was developed that included a model for decision-making support, e-tools, and accompanying resources and was implemented using an online, asynchronous learning management system. This pre-test, post-test, and follow-up survey study design aimed to increase nurses' and dietitians' levels of knowledge and confidence regarding vitamin D, aid in their translation of evidence into spheres of practice and influence, and help them identify translation barriers. The completion of the toolkit increased the participants' (n = 119) knowledge from 31% to 65% (p < 0.001) and their confidence from 2.0 to 3.3 (p < 0.001) on a scale of 1-5. Respondents reported using the model (100%) as a framework to successfully guide the translation of vitamin D knowledge into their sphere of influence or practice (94%) and identifying translation barriers. The toolkit should be included in interdisciplinary continuing education, research/quality improvement initiatives, healthcare policy, and institutions of higher learning to increase the movement of research into practice.
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Affiliation(s)
- Beth S Sanford
- School of Nursing, Rasmussen University, 4012 19th Avenue South, Fargo, ND 58103, USA
| | - Jennifer L Aliano
- GrassrootsHealth Nutrient Research Institute, Encinitas, CA 92024, USA
| | - Courtney S Omary
- School of Nursing, Rasmussen University, 4012 19th Avenue South, Fargo, ND 58103, USA
| | | | | | - William B Grant
- Sunlight, Nutrition, and Health Research Center, San Francisco, CA 94164-1603, USA
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Gayam V, Mandal AK, Ditah CM, Sidhu J, Konala VM, Adapa S, Naramala S, Garlapati P. Outcomes of Clostridioides difficile in Patients with Vitamin D Deficiency: A Propensity-Matched National Inpatient Sample Analysis. South Med J 2020; 113:593-599. [PMID: 33140114 DOI: 10.14423/smj.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We aimed to determine in-hospital outcomes, length of hospital stay, and resource utilization in a contemporary cohort of Clostridioides difficile infection (CDI) and vitamin D deficiency (VDD). METHODS The National Inpatient Sample database for 2016 and 2017 was used for data analysis using International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) codes to identify the patients with the principal diagnosis of CDI and VDD. We assessed the all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between propensity-matched groups of CDI without VDD versus CDI with VDD. RESULTS We identified 202,234 patients with CDI, 4515 of whom were patients with VDD and 197,719 of whom were without VDD. After propensity matching, there was no difference in the in-hospital mortality between the two groups (odds ratio [OR] 1.5, 95% confidence interval [CI] 0.58-4.3; P = 0.90). CDI with VDD has a higher odds of sepsis (OR 1.6, 95% CI 1.3-1.9; P = 0.0), and peritonitis (OR 1.6, 95% CI 1.4-3.8; P = 0.01). Mean LOS (5.9 ± 1.8 vs 5.4 ± 2, P < 0.01) and mean total charges ($11,500 vs $9971, P < 0.04) were higher in CDI with VDD. The factors affecting the LOS were acute coronary syndrome (P = 0.04), mechanical ventilation (P = 0.03), obesity (P = 0.004), acute kidney injury (P = 0.04), and sepsis (P = 0.05). CONCLUSIONS In this large cohort in a propensity-matched analysis, VDD does not increase the in-hospital mortality in CDI. VDD increases the odds of complications with a higher LOS and resource utilization. These findings may be clinically relevant to guide clinicians to routinely monitor vitamin D status and supplement in patients at risk of CDI.
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Affiliation(s)
- Vijay Gayam
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
| | - Amrendra Kumar Mandal
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
| | - Chobufo Muchi Ditah
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
| | - Jasdeep Sidhu
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
| | - Venu Madhav Konala
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
| | - Sreedhar Adapa
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
| | - Srikanth Naramala
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
| | - Pavani Garlapati
- From the Department of Internal Medicine, Interfaith Medical Center, Brooklyn, New York, the Department of Internal Medicine, Division of Medical Oncology, Ashland Bellefonte Cancer Center, Ashland, Kentucky, the Division of Nephrology, The Nephrology Group, Fresno, California, and the Department of Internal Medicine, Division of Rheumatology, Adventist Medical Center, Hanford, California
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Laviano E, Sanchez M, González-Nicolás MT, Palacian MP, López J, Gilaberte Y, Calmarza P, Rezusta A, Serrablo A. Surgical site infection in hepatobiliary surgery patients and its relationship with serum vitamin D concentration. Cir Esp 2020; 98:456-464. [PMID: 32723503 DOI: 10.1016/j.ciresp.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION While several studies have examined the correlation between vitamin D concentrations and post-surgical nosocomial infections, this relationship has yet to be characterized in hepatobiliary surgery patients. We investigated the relationship between serum vitamin D concentration and the incidence of surgical site infection (SSI) in patients in our hepatobiliary surgery unit. METHODS Participants in this observational study were 321 successive patients who underwent the following types of interventions in the hepatobiliary surgery unit of our center over a 1-year period: cholecystectomy, pancreaticoduodenectomy, total pancreatectomy, segmentectomy, hepatectomy, hepaticojejunostomy and exploratory laparotomy. Serum vitamin D levels were measured upon admission and patients were followed up for 1 month. Mean group values were compared using a Student's T-test or Chi-squared test. Statistical analyses were performed using the Student's T-test, the Chi-squared test, or logistic regression models. RESULTS Serum concentrations >33.5 nmol/l reduced the risk of SSI by 50%. Out of the 321 patients analyzed, 25.8% developed SSI, mainly due to organ-cavity infections (incidence, 24.3%). Serum concentrations of over 33.5 nmol/l reduced the risk of SSI by 50%. CONCLUSIONS High serum levels of vitamin D are a protective factor against SSI (OR, 0.99). Our results suggest a direct relationship between serum vitamin D concentrations and SSI, underscoring the need for prospective studies to assess the potential benefits of vitamin D in SSI prevention.
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Affiliation(s)
- Estefania Laviano
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España.
| | - María Sanchez
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España
| | | | | | - Javier López
- Medicina Familiar y Comunitaria, Sector II, Zaragoza, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica, Hospital Miguel Servet, Zaragoza, España
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Miguel Servet, Zaragoza, España
| | - Alejandro Serrablo
- Servicio de Cirugía General y Digestiva, Hospital Miguel Servet, Zaragoza, España
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McKinney TJ, Patel JJ, Benns MV, Nash NA, Miller KR. Vitamin D Status and Supplementation in the Critically Ill. Curr Gastroenterol Rep 2016; 18:18. [PMID: 26951231 DOI: 10.1007/s11894-016-0492-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Vitamin D deficiency has recently been recognized as a widespread global disorder. Generally considered a direct extension of malnutrition, even subclinical hypovitaminosis D is now recognized in adequately nourished populations. Compared to the general population, the prevalence of hypovitaminosis D is greater in the critically ill population. In fact, several studies have shown poorer outcomes in critically ill patients discovered to be vitamin D deficient or insufficient. Controversy persists regarding vitamin D measurements, quantity of supplementation, and appropriate target level in various populations. Vitamin D has a vital role in calcium homeostasis and extra-skeletal health, such as immune function. Therefore, vitamin D supplementation may have a role for improving outcomes in critically ill patients. In this review, we will first discuss the metabolism and function of vitamin D under normal physiologic conditions. We will then explore the prevalence and prognostic value of vitamin D deficiency in critical illness. Finally, we will examine recent trials focusing on appropriate dosing, route of administration, and outcomes associated with vitamin D supplementation in the ICU.
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Affiliation(s)
- T J McKinney
- Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY, 20222, USA
| | - Jayshil J Patel
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Matthew V Benns
- Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY, 20222, USA
| | - Nicholas A Nash
- Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY, 20222, USA
| | - Keith R Miller
- Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, Louisville, KY, 20222, USA.
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7
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Micic D, Rao K, Trindade BC, Walk ST, Chenoweth E, Jain R, Trivedi I, Santhosh K, Young VB, Aronoff DM. Serum 25-Hydroxyvitamin D Levels are not Associated with Adverse Outcomes in Clostridium Difficile Infection. Infect Dis Rep 2015; 7:5979. [PMID: 26500740 PMCID: PMC4593886 DOI: 10.4081/idr.2015.5979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/26/2015] [Accepted: 06/26/2015] [Indexed: 01/03/2023] Open
Abstract
Clostridium difficile infection (CDI) is a significant source of healthcare-associated morbidity and mortality. This study investigated whether serum 25-hydroxyvitamin D is associated with adverse outcomes from CDI. Patients with CDI were prospectively enrolled. Charts were reviewed and serum 25-hydroxyvitamin D was measured. The primary outcome was a composite definition of severe disease: fever (temperature >38°C), acute organ dysfunction, or serum white blood cell count >15,000 cells/µL within 24-48 hours of diagnosis; lack of response to therapy by day 5; and intensive care unit admission; colectomy; or death within 30 days. Sixty-seven patients were included in the final analysis. Mean (±SD) serum 25-hydroxyvitamin D was 26.1 (±18.54) ng/mL. Severe disease, which occurred in 26 (39%) participants, was not associated with serum 25-hydroxyvitamin D [odds ratio (OR) 1.00; 95% confidence interval (CI) 0.96-1.04]. In the adjusted model for severe disease only serum albumin (OR 0.12; 95%CI 0.02-0.64) and diagnosis by detection of stool toxin (OR 5.87; 95%CI 1.09-31.7) remained independent predictors. We conclude that serum 25-hydroxyvitamin D is not associated with the development of severe disease in patients with CDI.
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Affiliation(s)
- Dejan Micic
- Division of Gastroenterology, Hepatology and Nutrition, University of Chicago , IL, USA
| | - Krishna Rao
- Department of Internal Medicine, University of Michigan Health System , Ann Arbor, MI, USA ; Division of Infectious Diseases, University of Michigan Health System , Ann Arbor, MI, USA
| | - Bruno Caetano Trindade
- Department of Internal Medicine, University of Michigan Health System , Ann Arbor, MI, USA ; Department of Microbiology and Immunology, University of Michigan Health System , Ann Arbor, MI, USA
| | - Seth T Walk
- Department of Internal Medicine, University of Michigan Health System , Ann Arbor, MI, USA ; Division of Infectious Diseases, University of Michigan Health System , Ann Arbor, MI, USA
| | | | - Ruchika Jain
- Department of Internal Medicine, University of Michigan Health System , Ann Arbor, MI, USA ; Division of Infectious Diseases, University of Michigan Health System , Ann Arbor, MI, USA
| | - Itishree Trivedi
- Department of Internal Medicine, University of Michigan Health System , Ann Arbor, MI, USA
| | - Kavitha Santhosh
- Department of Internal Medicine, University of Michigan Health System , Ann Arbor, MI, USA ; Division of Infectious Diseases, University of Michigan Health System , Ann Arbor, MI, USA
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8
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Low vitamin D level and impact on severity and recurrence of Clostridium difficile infections. J Investig Med 2015; 63:17-21. [PMID: 25479065 DOI: 10.1097/jim.0000000000000117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) has recently markedly increased, incurring greater health care-associated costs and hospitalizations especially in vitamin D deficient patients. Accordingly, the aim of this study was to evaluate the relationship between low vitamin D levels and the severity and recurrence of CDI. METHODS A retrospective case-control study evaluated patients hospitalized between 2007 and 2013 with CDI and a positive C. difficile toxin assay. Severe complicated CDI was defined based on (1) laboratory or radiological criteria correlated clinically and (2) sepsis requiring intensive care unit admission. Recurrent CDI (RCDI) was defined as a new episode of diarrhea occurring within 90 days of resolution of the initial episode for at least 10 days after discontinuing therapy and confirmed by positive stool C. difficile toxin assay or polymerase chain reaction. Patients were divided into 4 groups based on vitamin D level (ng/mL): severely deficient (<10), insufficient (10-19.9), predeficient (20-29.9), and control group (≥30). RESULTS Two hundred seventy-one patients were diagnosed with CDI, of which 48 had RCDI distributed as 5 (12.5%), 15 (16.1%), 10 (15.6%), and 13 (17.5%) patients in each of the aforementioned groups, respectively (P=0.55). Severe complicated CDI was identified in 7 (17.5%), 17 (18.2%), 9 (14%), and 3 (4%) patients, respectively (P=0.04). Thirty-day mortality was 1 of 40, 1 of 93, 2 of 64, and 2 of 74 patients, respectively (P=0.43). CONCLUSIONS Normal vitamin D level has a protective effect against severe CDI, and low vitamin D is associated with greater severity of CDI but not with an increased risk of RCDI or 30-day mortality.
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Thomason J, Rentsch C, Stenehjem EA, Hidron AI, Rimland D. Association between vitamin D deficiency and methicillin-resistant Staphylococcus aureus infection. Infection 2015; 43:715-22. [DOI: 10.1007/s15010-015-0815-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 06/20/2015] [Indexed: 01/18/2023]
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Govani SM, Waljee AK, Stidham RW, Higgins PD. Increasing ultraviolet light exposure is associated with reduced mortality from Clostridium difficile infection. United European Gastroenterol J 2015; 3:208-14. [PMID: 25984339 DOI: 10.1177/2050640614567185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/09/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clostridium difficile infection (CDI) is an increasingly common cause of inpatient mortality. Vitamin D deficiency is associated with more aggressive CDI. We aimed to determine if average annual ultraviolet light (UV) exposure was associated with mortality in patients with CDI. METHODS We used the US National Inpatient Sample (NIS) from 2004-2011 to assess the mortality risk in patients with a diagnosis of CDI (as per ICD-9CM 008.45). Annual average state UV exposure was assigned to each hospitalization. Logistic regression was used to determine the effects of UV exposure on mortality, controlling for age, gender, race and other comorbidities. RESULTS During the study period, there were 2.61 million hospitalizations with a diagnosis of CDI. The mortality rate was 9.0%. In univariate analysis, the odds ratio (OR) of inpatient mortality for the UV index was 0.97 (95% CI 0.95-0.99; p = 0.008) per unit of UV exposure. In a multivariable model adjusting for age, gender, race, Charlson-Deyo index, season and coexisting inflammatory bowel disease, the UV index remained a protective predictor, with an OR of 0.94 (95% CI 0.92-0.96; p < 0.001). In the multivariate model, a seasonal effect was also present, with the highest risk of inpatient mortality in the period from January to March (OR 1.11; 95% CI 1.08-1.14) and the lowest risk, from July to September (OR 0.95; 95% CI 0.92-0.98). CONCLUSIONS An increase in UV exposure index is associated with a reduced risk of inpatient mortality in patients with CDI. A seasonal effect is also present, with the highest risk of death during winter months. Further studies exploring the role of UV light in CDI are necessary.
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Affiliation(s)
- Shail M Govani
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Akbar K Waljee
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA ; Center for Clinical Management Research, US Department of Veteran's Affairs, Ann Arbor, MI, USA
| | - Ryan W Stidham
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Peter Dr Higgins
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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11
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Wong KK, Lee R, Watkins RR, Haller N. Prolonged Clostridium difficile Infection May Be Associated With Vitamin D Deficiency. JPEN J Parenter Enteral Nutr 2015; 40:682-7. [DOI: 10.1177/0148607114568121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Ken Koon Wong
- Department of Internal Medicine, Akron General Medical Center, Akron, Ohio
| | - Rebecca Lee
- Department of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Richard R. Watkins
- Department of Internal Medicine, Akron General Medical Center, Akron, Ohio
- Department of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
- Division of Infectious Disease, Akron General Medical Center, Akron, Ohio
| | - Nairmeen Haller
- Department of Internal Medicine, Akron General Medical Center, Akron, Ohio
- Department of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
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12
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Sahay T, Ananthakrishnan AN. Vitamin D deficiency is associated with community-acquired clostridium difficile infection: a case-control study. BMC Infect Dis 2014; 14:661. [PMID: 25471926 PMCID: PMC4258019 DOI: 10.1186/s12879-014-0661-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/24/2014] [Indexed: 01/01/2023] Open
Abstract
Background Clostridium difficile infection (CDI) is increasingly recognized as an important community acquired pathogen causing disease (CA-CDI). Vitamin D [25(OH)D] has immune modulatory effects and plays an important role in intestinal immunity. The role of vitamin D in CA-CDI has not been examined previously. Methods This was a single referral center case–control study. Cases comprised of all patients with CA-CDI who had a serum 25(OH)D measured within 12 months prior to infection. Controls were drawn from patients who had 25(OH)D checked and matched based on age, gender, race and health status. Serum 25(OH)D was stratified as < 15 ng/mL, 15-30 ng/mL or > 30 ng/mL. Regression models adjusting for potential confounders were used to define independent association between vitamin D and CA-CDI. Results We identified 58 matched case–control pairs (66% women; 85% Caucasian). The mean age was 62 years. The mean serum 25(OH)D level was significantly lower in CA-CDI cases compared to controls (28.5 ng/mL vs. 33.8 ng/mL, p = 0.046). Cases had higher rate of antibiotic exposure and more comorbidity. Serum 25(OH)D < 15 ng/mL was associated with an increased risk of CA-CDI on univariate (Odds ratio (OR) 5.10, 95% confidence interval (CI) 1.51 – 17.24) and multivariate analysis (OR 3.84, 95% CI 1.10 – 13.42). Vitamin D levels between 15-30 ng/mL did not modify disease risk. Conclusions Low serum 25(OH)D < 15 ng/mL was associated with increased risk of CA-CDI. This suggests vitamin D may have a role in determining susceptibility to CA-CDI.
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Ananthakrishnan AN, Cagan A, Gainer VS, Cheng SC, Cai T, Szolovits P, Shaw SY, Churchill S, Karlson EW, Murphy SN, Kohane I, Liao KP. Higher plasma vitamin D is associated with reduced risk of Clostridium difficile infection in patients with inflammatory bowel diseases. Aliment Pharmacol Ther 2014; 39:1136-42. [PMID: 24641590 PMCID: PMC4187206 DOI: 10.1111/apt.12706] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/23/2014] [Accepted: 02/25/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBD) have an increased risk of clostridium difficile infection (CDI). Cathelicidins are anti-microbial peptides that attenuate colitis and inhibit the effect of clostridial toxins. Plasma calcifediol [25(OH)D] stimulates production of cathelicidins. AIM To examine the association between plasma 25(OH)D and CDI in patients with IBD. METHODS From a multi-institutional IBD cohort, we identified patients with at least one measured plasma 25(OH)D. Our primary outcome was development of CDI. Multivariate logistic regression models adjusting for potential confounders were used to identify independent effect of plasma 25(OH)D on risk of CDI. RESULTS We studied 3188 IBD patients of whom 35 patients developed CDI. Patients with CDI-IBD were older and had greater co-morbidity. The mean plasma 25(OH)D level was significantly lower in patients who developed CDI (20.4 ng/mL) compared to non-CDI-IBD patients (27.1 ng/mL) (P = 0.002). On multivariate analysis, each 1 ng/mL increase in plasma 25(OH)D was associated with a 4% reduction in risk of CDI (OR 0.96, 95% CI 0.93-0.99, P = 0.046). Compared to individuals with vitamin D >20 ng/mL, patients with levels <20 ng/mL were more likely to develop CDI (OR 2.27, 95% CI 1.16-4.44). The mean plasma 25(OH)D in patients with CDI who subsequently died was significantly lower (12.8 ± 8.1 ng/mL) compared to those who were alive at the end of follow-up (24.3 ± 13.2 ng/mL) (P = 0.01). CONCLUSIONS Higher plasma calcifediol [25(OH)D] is associated with reduced risk of C. difficile infection in patients with IBD. Further studies of therapeutic supplementation of vitamin D in patients with inflammatory bowel disease and C. difficile infection may be warranted.
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Affiliation(s)
- Ashwin N. Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Andrew Cagan
- Research IS and Computing, Partners HealthCare, Charlestown, MA
| | | | - Su-Chun Cheng
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Tianxi Cai
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | | | - Stanley Y Shaw
- Harvard Medical School, Boston, MA,Center for Systems Biology, Massachusetts General Hospital, Boston, MA
| | - Susanne Churchill
- i2b2 National Center for Biomedical Computing, Brigham and Women’s Hospital, Boston, MA
| | - Elizabeth W. Karlson
- Harvard Medical School, Boston, MA,Division of Rheumatology, Allergy and Immunology, Brigham and Women’s Hospital, Boston, MA
| | - Shawn N. Murphy
- Harvard Medical School, Boston, MA,Research IS and Computing, Partners HealthCare, Charlestown, MA,Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Isaac Kohane
- Harvard Medical School, Boston, MA,Children’s Hospital Boston, Boston, MA,i2b2 National Center for Biomedical Computing, Brigham and Women’s Hospital, Boston, MA
| | - Katherine P. Liao
- Harvard Medical School, Boston, MA,Division of Rheumatology, Allergy and Immunology, Brigham and Women’s Hospital, Boston, MA
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Quraishi SA, Litonjua AA, Moromizato T, Gibbons FK, Camargo CA, Giovannucci E, Christopher KB. Association between prehospital vitamin D status and hospital-acquired Clostridium difficile infections. JPEN J Parenter Enteral Nutr 2014; 39:47-55. [PMID: 24492311 DOI: 10.1177/0148607113511991] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate whether preadmission 25-hydroxyvitamin D (25(OH)D) levels are associated with the risk of hospital-acquired Clostridium difficile infection (HACDI). MATERIALS AND METHODS Our retrospective cohort study focused on 568 adult patients from 2 Boston teaching hospitals between August 1993 and November 2006. All patients had 25(OH)D levels measured before hospitalization and were at risk for HACDI (defined as the presence of C difficile toxin A or B in stool samples obtained >48 hours after hospitalization). We performed multivariable regression analyses to test the association of prehospital 25(OH)D levels with HACDI while adjusting for clinically relevant covariates. RESULTS In these 568 patients, mean (SD) 25(OH)D level was 19 (12) ng/mL, and 11% of patients met criteria for incident HACDI. Following adjustment for age, sex, race (nonwhite vs white), patient type (medical vs surgical), and Deyo-Charlson index, patients with 25(OH)D levels <10 ng/mL had higher odds of HACDI (odds ratio [OR], 2.90; 95% confidence interval [CI], 1.01-8.34) compared with patients with 25(OH)D levels ≥30 ng/mL. When patients with HACDI were analyzed relative to a larger patient cohort without HACDI (n = 5047), those with 25(OH)D levels <10 ng/mL (OR, 4.96; 95% CI, 1.84-13.38) and 10-19.9 ng/mL (OR, 3.36; 95% CI, 1.28-8.85) had higher adjusted odds of HACDI compared with patients with 25(OH)D levels ≥30 ng/mL. CONCLUSIONS In our cohort of adult patients, vitamin D status before hospital admission was inversely associated with the risk of developing HACDI. These data support the need for randomized, controlled trials to test the role of vitamin D supplementation to prevent HACDI.
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Affiliation(s)
- Sadeq A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston
| | - Augusto A Litonjua
- Channing Division of Network Medicine and Pulmonary and Critical Care Division Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Takuhiro Moromizato
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fiona K Gibbons
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Edward Giovannucci
- Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Kenneth B Christopher
- The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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van der Wilden GM, Fagenholz PJ, Velmahos GC, Quraishi SA, Schipper IB, Camargo CA. Vitamin D status and severity of Clostridium difficile infections: a prospective cohort study in hospitalized adults. JPEN J Parenter Enteral Nutr 2014; 39:465-70. [PMID: 24408036 DOI: 10.1177/0148607113519129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/11/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clostridium difficile is the most common cause of nosocomial diarrhea, affecting up to 10% of hospitalized patients. Preliminary studies suggest an association between vitamin D status and C difficile infections (CDIs). Our goal was to investigate whether serum 25-hydroxyvitamin D (25(OH)D) levels are associated with CDI severity. METHODS We prospectively enrolled patients diagnosed with CDI and divided them into 2 severity groups: group A (positive toxin A/B enzyme immunoassay only) and group B (positive toxin A/B enzyme immunoassay with abdominal computed tomography scan findings consistent with colitis). Serum 25(OH)D levels (25(OH)D3, 25(OH)D2, and total 25(OH)D) were measured on all patients after diagnosis of CDI. We performed multivariable logistic regression analyses to investigate the association between 25(OH)D levels and CDI severity, while adjusting for age, Deyo-Charlson Comorbidity Index, recent hospitalization, and vitamin D supplementation. RESULTS One hundred patients were enrolled between July 2011 and February 2013. The mean (standard deviation) cohort age and Deyo-Charlson Comorbidity Index were 62 (19) years and 4 (3), respectively; 54% of patients were male. Mean serum total 25(OH)D level was 22 (10) ng/mL. Mean 25(OH)D3 level was significantly higher in group A (n = 71) than in group B (n = 29): 21 (1) vs 15 (2) ng/mL, respectively (P = .005). There was no observed difference in mean 25(OH)D2 levels and total 25(OH)D levels between the 2 groups. Multivariable logistic regression analysis demonstrated an association between 25(OH)D3 levels and CDI severity (adjusted odds ratio, 0.92; 95% confidence interval, 0.87-0.98). CONCLUSIONS We found a significant inverse association between 25(OH)D3 levels and CDI severity. Further studies are needed to determine whether vitamin D supplementation can improve outcomes in patients with CDI.
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Affiliation(s)
- Gwendolyn M van der Wilden
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston Department of Surgery and Trauma Surgery, Leiden University Medical Center and Leiden University, Leiden, the Netherlands
| | - Peter J Fagenholz
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston
| | - George C Velmahos
- Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Sadeq A Quraishi
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Inger B Schipper
- Department of Surgery and Trauma Surgery, Leiden University Medical Center and Leiden University, Leiden, the Netherlands
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
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16
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Sollid J, Furberg A, Hanssen A, Johannessen M. Staphylococcus aureus: Determinants of human carriage. INFECTION GENETICS AND EVOLUTION 2014; 21:531-41. [DOI: 10.1016/j.meegid.2013.03.020] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/15/2013] [Accepted: 03/16/2013] [Indexed: 02/02/2023]
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17
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Wang WJ, Gray S, Sison C, Arramraju S, John BK, Hussain SA, Kim SH, Mehta P, Rubin M. Low vitamin D level is an independent predictor of poor outcomes in Clostridium difficile-associated diarrhea. Therap Adv Gastroenterol 2014; 7:14-9. [PMID: 24381644 PMCID: PMC3871280 DOI: 10.1177/1756283x13502838] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The incidence, recurrence, and all-cause mortality rate for Clostridium difficile-associated diarrhea (CDAD) has increased markedly over the past 10 years despite treatment. Low vitamin D levels are known to impair immune responses to infection and are associated with increased mortality. We compared the role of patient comorbidity measured by the Charlson Comorbidity Index (CCI) with vitamin D levels to ascertain whether vitamin D levels were an independent variable affecting the outcome of CDAD or a marker of overall comorbidity. METHODS A prospective cohort study studied 62 patients hospitalized between 2008 and 2009 with manifestations of CDAD and a positive C. difficile toxin assay. All patients received standard antibiotics (metronidazole and/or vancomycin). Their status at 30-day follow up was classified as resolved or recurred/expired. Patients' CCI was calculated using their medical history. Logistic regression analysis of variables including 25-hydroxyvitamin D, CCI, age, gender, white blood cell count (WBC), albumin and residence type were performed. RESULTS There were 62 patients (43.6% men, 56.4% women) with CDAD; mean age was 75 ± 17 years. At 30-day follow up, 28 (45.2%) expired, 10 (16.1%) had persistent or recurrent diarrhea and 24 (38.7%) resolved. Nonresolution was seen in 38 (61.3%). There was no significant association between 30-day resolution status and CCI, gender, WBC, albumin level or residence type. Two variables were found to be independent predictors of resolution of CDAD: normal vitamin D levels (p = 0.028) and age <70 years (p = 0.024). Subjects with low vitamin D were 4.75 times more likely to fail to resolve CDAD than subjects with normal Vitamin D. CONCLUSION In this study, vitamin D level and age are independent predictors of CDAD resolution in hospitalized patients. Low vitamin D levels and age >70 years old are associated with increased likelihood of recurrence. Low vitamin D levels are not a marker of comorbidity or advanced age.
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Affiliation(s)
- Wallace J Wang
- Department of Gastroenterology, New York Hospital Queens/Weill Cornell Medical College, 56-45 Main Street, Flushing, NY 11355, USA
| | - Sondra Gray
- Department of Medicine, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA
| | - Cristina Sison
- Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Biostatistics Unit, Manhasset, NY, USA
| | - Sushma Arramraju
- Department of Medicine, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA
| | - Bijo K John
- Department of Medicine, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA
| | - Syed A Hussain
- Department of Gastroenterology, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA
| | - Sang H Kim
- Department of Gastroenterology, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA
| | - Preeti Mehta
- Department of Gastroenterology, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA
| | - Moshe Rubin
- Department of Gastroenterology, New York Hospital Queens/Weill Cornell Medical College, Flushing NY, USA
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18
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Curtis L. More nutritional research needed to prevent and treat Clostridium difficile infections. Am J Gastroenterol 2013; 108:1813-4. [PMID: 24192962 DOI: 10.1038/ajg.2013.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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19
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Youssef D, Grant WB, Peiris AN. Vitamin D deficiency: A potential risk factor for Clostridium difficile infection. Risk Manag Healthc Policy 2012; 5:115-6. [PMID: 23097616 PMCID: PMC3476371 DOI: 10.2147/rmhp.s36781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Dima Youssef
- Department of Internal Medicine, Division of Infectious Diseases, San Francisco, CA USA
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20
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Youssef DA, Ranasinghe T, Grant WB, Peiris AN. Vitamin D's potential to reduce the risk of hospital-acquired infections. DERMATO-ENDOCRINOLOGY 2012; 4:167-75. [PMID: 22928073 PMCID: PMC3427196 DOI: 10.4161/derm.20789] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Health care–associated and hospital-acquired infections are two entities associated with increased morbidity and mortality. They are highly costly and constitute a great burden to the health care system. Vitamin D deficiency (< 20 ng/ml) is prevalent and may be a key contributor to both acute and chronic ill health. Vitamin D deficiency is associated with decreased innate immunity and increased risk for infections. Vitamin D can positively influence a wide variety of microbial infections.
Herein we discuss hospital-acquired infections, such as pneumonia, bacteremias, urinary tract and surgical site infections, and the potential role vitamin D may play in ameliorating them. We also discuss how vitamin D might positively influence these infections and help contain health care costs. Pending further studies, we think it is prudent to check vitamin D status at hospital admission and to take immediate steps to address existing insufficient 25-hydroxyvitamin D levels.
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Kempker JA, Han JE, Tangpricha V, Ziegler TR, Martin GS. Vitamin D and sepsis: An emerging relationship. DERMATO-ENDOCRINOLOGY 2012; 4:101-8. [PMID: 22928065 PMCID: PMC3427188 DOI: 10.4161/derm.19859] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Vitamin D insufficiency and sepsis are both highly prevalent worldwide problems and this article reviews the emerging science that is defining the intersections of these conditions. The importance of vitamin D’s role in skeletal health has long been understood but recent evidence is beginning to highlight its role in the functioning of other physiologic systems of the body. Basic science data reveal its integral role in local immune responses to pathogens and the systemic inflammatory pathways of sepsis. Furthermore, clinical scientists have found associations with respiratory infections, critical illness and sepsis but the causal relationship and its clinical impact have yet to be clearly defined. The article ends with speculations on the connections between racial disparities and seasonal differences in sepsis and vitamin D insufficiency.
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Youssef DA, Miller CW, El-Abbassi AM, Cutchins DC, Cutchins C, Grant WB, Peiris AN. Antimicrobial implications of vitamin D. DERMATO-ENDOCRINOLOGY 2011; 3:220-9. [PMID: 22259647 DOI: 10.4161/derm.3.4.15027] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Revised: 01/12/2011] [Accepted: 01/24/2011] [Indexed: 12/14/2022]
Abstract
Evidence exists that vitamin D has a potential antimicrobial activity and its deficiency has deleterious effects on general well-being and longevity. Vitamin D may reduce the risk of infection through multiple mechanisms. Vitamin D boosts innate immunity by modulating production of anti-microbial peptides (AMPs) and cytokine response. Vitamin D and its analogues via these mechanisms are playing an increasing role in the management of atopic dermatitis, psoriasis, vitiligo, acne and rosacea. Vitamin D may reduce susceptibility to infection in patients with atopic dermatitis and the ability to regulate local immune and inflammatory responses offers exciting potential for understanding and treating chronic inflammatory dermatitides. Moreover, B and T cell activation as well as boosting the activity of monocytes and macrophages also contribute to a potent systemic anti-microbial effect. The direct invasion by pathogenic organisms may be minimized at sites such as the respiratory tract by enhancing clearance of invading organisms. A vitamin D replete state appears to benefit most infections, with the possible noteworthy exception of Leishmaniasis. Antibiotics remain an expensive option and misuse of these agents results in significant antibiotic resistance and contributes to escalating health care costs. Vitamin D constitutes an inexpensive prophylactic option and possibly therapeutic product either by itself or as a synergistic agent to traditional antimicrobial agents. This review outlines the specific antimicrobial properties of vitamin D in combating a wide range of organisms. We discuss the possible mechanisms by which vitamin D may have a therapeutic role in managing a variety of infections.
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Affiliation(s)
- Dima A Youssef
- Mountain Home VAMC Medicine Service; Mountain Home; TN USA
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23
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Olsen K, Falch BM, Danielsen K, Johannessen M, Ericson Sollid JU, Thune I, Grimnes G, Jorde R, Simonsen GS, Furberg AS. Staphylococcus aureus nasal carriage is associated with serum 25-hydroxyvitamin D levels, gender and smoking status. The Tromsø Staph and Skin Study. Eur J Clin Microbiol Infect Dis 2011; 31:465-73. [PMID: 21811869 PMCID: PMC3303067 DOI: 10.1007/s10096-011-1331-x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/18/2011] [Indexed: 11/28/2022]
Abstract
Vitamin D induces the expression of antimicrobial peptides with activity against Staphylococcus aureus. Thus, we studied the association between serum 25-hydroxyvitamin D (25(OH)D) and S. aureus nasal colonization and carriage. Nasal swabs, blood samples and clinical data from 2,115 women and 1,674 men, aged 30-87 years, were collected in the Tromsø Staph and Skin Study 2007-08, as part of the population-based sixth Tromsø Study. Multivariate logistic regression analyses were stratified by recognized risk factors for S. aureus carriage: sex, age and smoking. In non-smoking men, we observed a 6.6% and 6.7% decrease in the probability of S. aureus colonization and carriage, respectively, by each 5 nmol/l increase in serum 25(OH)D concentration (P < 0.001 and P = 0.001), and serum 25(OH)D > 59 nmol/l and ≥75 nmol/l as thresholds for ~30% and ~50% reduction in S. aureus colonization and carriage. In non-smoking men aged 44-60 years, the odds ratio for S. aureus colonization was 0.44 (95% confidence interval, 0.28-0.69) in the top tertile of serum 25(OH)D versus the bottom tertile. In women and smokers there were no such associations. Our study supports that serum vitamin D is a determinant of S. aureus colonization and carriage.
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Affiliation(s)
- K Olsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, 9038, Tromsø, Norway.
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Youssef D, Bailey B, El-Abbassi A, Vannoy M, Manning T, Moorman JP, Peiris AN. Healthcare costs of methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa infections in veterans: role of vitamin D deficiency. Eur J Clin Microbiol Infect Dis 2011; 31:281-6. [PMID: 21695580 DOI: 10.1007/s10096-011-1308-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 05/23/2011] [Indexed: 01/28/2023]
Abstract
Methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (P. aeruginosa) infections are frequently associated with hospitalization and increased healthcare costs. Vitamin D deficiency may contribute to increased costs for patients with these infections and there is evidence that vitamin D may have an antimicrobial role. To evaluate the role of vitamin D deficiency in the costs incurred with these infections, we studied the relationship of serum 25(OH)D levels to healthcare costs in veterans in the southeastern United States. Patients with both infections were vitamin D deficient to a similar extent and so were combined for further analysis. Vitamin D deficient patients had higher costs and service utilization than those who were not vitamin D deficient. Those with vitamin D deficiency had higher inpatient costs compared to the non-deficient group, and this difference was across most categories except for the number of inpatient hospitalizations or total number of days as an inpatient. Vitamin D deficiency was not significantly related to outpatient cost or service utilization parameters. We conclude that vitamin D deficiency is intimately linked to adverse healthcare costs in veterans with MRSA and P. aeruginosa infections. Vitamin D status should be assayed in patients with these infections.
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Affiliation(s)
- D Youssef
- Department of Internal Medicine, Division of Infectious Diseases, East Tennessee State University, Johnson City, TN, USA.
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Youssef DA, El Abbassi AM, Cutchins DC, Chhabra S, Peiris AN. Vitamin D deficiency: Implications for acute care in the elderly and in patients with chronic illness. Geriatr Gerontol Int 2011; 11:395-407. [DOI: 10.1111/j.1447-0594.2011.00716.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Vitamin D: Lessons from the Veterans Population. J Am Med Dir Assoc 2011; 12:257-62. [DOI: 10.1016/j.jamda.2010.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 08/10/2010] [Indexed: 11/23/2022]
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